Suicide Attempt Survivors Research Articles

How do health care services help and hinder recovery after a suicide attempt? A qualitative analysis of Finnish service user perspectives

BackgroundSuicide attempt survivors are at high risk of re-attempts and suicide death. Previous research has shown that service users’ experiences of post-attempt care are related to future treatment engagement and re-attempts. In-depth understanding of how current services meet service users’ needs in the period immediately following a suicide attempt is thus imperative for the development of more effective tertiary prevention practices in real-life health care systems.MethodIn this qualitative study, Finnish suicide attempt survivors’ experiences of and perspectives on mental health services were explored through a semi-structured interview. Participants were seven female and seven male service users interviewed 3–6 months after the index suicide attempt. A conventional content analysis of these service user interviews is presented.ResultsParticipants’ experiences of care ranged from helping to hindering recovery. Seven key aspects of services were described as helpful when present and hindering when absent. These included (1) meeting the service user as worthy of help, (2) supporting the exploration of personal meanings, (3) supporting the exploration of suicidality, (4) psychological continuity and predictability, (5) offering a responsive partnership in navigating recovery, (6) inviting service user involvement in medication decisions, and (7) accounting for service users’ relational context.ConclusionsCurrent health care services are inconsistent in meeting suicide attempt survivors’ subjective needs, leaving clear room for improvement in tertiary suicide prevention. To be perceived as meaningful by service users, services should strive to offer opportunities for both biomedical, psychological, and social interventions, with responsivity to individual needs and preferences. A focus on the social aspects of recovery (e.g., offering support to loved ones affected by the suicidal incident; facilitating peer support and social belonging) was most often found to be lacking in current services.

A one-year follow-up study of treatment-compliant suicide attempt survivors: relationship of CYP2D6-CYP2C19 and polypharmacy with suicide reattempts

This study of a cohort of 1-year treatment-compliant survivors of a suicide attempt examined for the first time whether a high CYP2D6-CYP2C19 metabolic capacity (pharmacogenes related to psychopathology, suicide, and attempt severity) and/or polypharmacy treatments predicted repeat suicide attempts, adjusting for sociodemographic and clinical factors as confounders. Of the 461 (63% women) consecutively hospitalized patients who attempted suicide and were evaluated and treated after an index attempt, 191 (67.5% women) attended their 6- and 12-month follow-up sessions. Clinicians were blinded to the activity scores (AS) of their genotypes, which were calculated as the sum of the values assigned to each allele (CYP2C19 *2, *17; CYP2D6 *3, *4, *4xN, *5, *6, *10, wtxN). No differences were found in polypharmacy prescription patterns and the variability of CYP2D6 and CYP2C19 genotypes between adherents and dropouts, but the formers were older, with a higher frequency of anxiety and bipolar disorders and fewer alcohol and substance use disorders. The risk of reattempts was higher for CYP2D6 ultrarapid (AS > 2) metabolizers (β = 0.561, p = 0.005) and violent suicide survivors (β = −0.219, p = 0.042) if the attempt occurred during the first 6-month period, individuals with an increased number of MINI DSM-IV Axis I mental disorders (β = 0.092, p = 0.032) during the second 6-month period and individuals with a combined high CYP2D6-CYP2C19 metabolic capacity (AS > 4) (β = 0.345, p = 0.024) and an increased use of drugs other than antidepressants, anxiolytics-depressants and antipsychotics-lithium (β = 0.088, p = 0.005) in multiple repeaters during both periods. CYP2D6 and CYP2C19 rapid metabolism and polypharmacy treatment for somatic comorbidities must be considered to prevent the severe side effects of short-term multiple suicide reattempts after a previous attempt.

16.1 The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): A Novel Tool for Reducing the Risk of Media-Influenced Suicide Contagion

16.1 The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): A Novel Tool for Reducing the Risk of Media-Influenced Suicide Contagion

Inferring sleep disturbance from text messages of suicide attempt survivors: A pilot study.

Identifying digital markers of sleep disturbance-a known suicide risk factor-may aid in the detection of imminent suicide risk. This study examined sleep-related communication and texting patterns in personal text messages (N=86,705) of suicide attempt survivors. Twenty-six participants provided dates of past suicide attempts and 2-week periods of positive mood, depressed mood, or suicidal ideation. Linguistic Inquiry Word Count was used to identify sleep-related texts via a custom dictionary. Mixed effect models were fitted to test the association between suicide/mood episode type (e.g., attempt versus ideation) and three outcomes: likelihood of a text including sleep-related content, nightly count of texts sent from midnight to 5:00 AM, and sum of unique hour bins from midnight to 5:00 AM with outgoing texts. Analyses with a sleep dictionary that was manually revised to be more accurate (but not the original unedited dictionary) showed sleep-related communication was more likely during depressed mood episodes than positive mood episodes. Otherwise, there were no significant differences in sleep-related communication or objective texting patterns across episode type. Although we did not detect differences in sleep-related communication tied to suicidal thoughts or behaviors, sleep-related communication may differ as a function of within-person mood level.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BackgroundMost people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts. MethodsEach US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors. ResultsIn each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9–1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4–7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60–0.78). LimitationsData were cross-sectional, limiting inferences about causation and directionality of associations. ConclusionsFindings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

COMPOSITE MIXTURE OF LOG-LINEAR MODELS WITH APPLICATION TO PSYCHIATRIC STUDIES.

Psychiatric studies of suicide provide fundamental insights on the evolution of severe psychopathologies, and contribute to the development of early treatment interventions. Our focus is on modelling different traits of psychosis and their interconnections, focusing on a case study on suicide attempt survivors. Such aspects are recorded via multivariate categorical data, involving a large numbers of items for multiple subjects. Current methods for multivariate categorical data-such as penalized log-linear models and latent structure analysis-are either limited to low-dimensional settings or include parameters with difficult interpretation. Motivated by this application, this article proposes a new class of approaches, which we refer to as Mixture of Log Linear models (mills). Combining latent class analysis and log-linear models, mills defines a novel Bayesian approach to model complex multivariate categorical data with flexibility and interpretability, providing interesting insights on the relationship between psychotic diseases and psychological aspects in suicide attempt survivors.

Long term Follow up Study of Phone Contacts in Catalonia

We’ll present the Catalan experience of follow up by phone contats of suicide attempters, and the results up to 10 years. We develop a Suicide Prevention Program that started with the EAAD project in 2008 in a 0,5 M people catchment area, later generalized to 7,5 M people through the Catalonia Suicide Risk Code (SRC-Cat). The SRC-cat is a real-time registry of suicide attempts (65% women) that allows immediate attention and telephone follow-up and ensures continuity of care for 12 months. To evaluate the effectiveness of our telephone management plan, we conducted two types of analysis; a) 12-month short-term analysis: non-randomised controlled analysis of suicide reattempts comparing two cities (2007-2008); b) 8-year long-term analysis with the evolution of suicide rates (men and women) between our area, and two other cities (territorial differences and over time from 2010 to 2017). Results: a) the SRC-Cat in our catchment area reduced significantly the proportion of people who re-attempt suicide by 57% over 12 months (from 14% to 6 %); b) we found lower standardized suicide death rate among women in our catchment area (both territorially and over time). Conclusions: a) Short-term telephone management (12-month), ensuring chain of care after hospital discharge, reduces more than 50% the proportion of patients who re-attempt; b) Long-term telephone management (8-year) of suicide attempt survivors over 12 months, significantly reduces suicide deaths in women only (64% of patients in telephone follow-up are women).DisclosureNo significant relationships.

To share or not to share? Evaluation of a strategic disclosure program for suicide attempt survivors

While suicide attempt survivors often choose to conceal their suicidal thoughts and behaviors to avoid stigma, concealment might also limit the support they receive. This study evaluated a peer-led strategic disclosure intervention for suicide attempt survivors (N = 38) who were randomized to either a 6-hour group disclosure intervention or waitlist control. Results showed a significant group-by-time interaction from baseline to post-intervention on two measures of self-stigma, depression, and self-esteem, but not for other variables. Effect sizes were medium to large. Findings suggest that suicide attempt survivors may benefit from interventions that address self-stigma and disclosure.

Exploring the Psychometric Properties of the Stigma of Suicide Scale Using a Sample of Adults Bereaved by Suicide and Suicide Attempt Survivors.

The Stigma of Suicide Scale (SOSS) is a measure of public attitudes toward suicide decedents, which makes it unique from other scales that measure more general attitudes toward suicide. The aim of this study was to further replicate and extend the reliability and factor structure of the SOSS (both long- and short form) in a sample of individuals directly impacted by suicide. This study also sought to identify factors that impact suicide attitudes unique to this sample. The sample included 312 participants who had personal experience with suicide. Results provided support for the oblique three-factor structure of the SOSS (stigma, isolation/depression, and glorification/normalization), with a superior model fit for the 16-item short form version. Correlates of suicide attitudes among individuals exposed to suicide included perceived relationship closeness to a suicide decedent, experience with both loss and attempt, and the sex of the suicide decedent.

Are Nonfatal Suicide Attempts Instrumental in Achieving Personal and Interpersonal Goals?

This study focused on the well-being of the survivors of suicide attempts and the well-being of their interpersonal relationships after the attempt. The data came from a sample of 392 college students from 10 Muslim majority countries who reported having attempted suicide in the last 4 years. Suicide was conceptualized as a goal-directed behavior embedded in a sociocultural context and motivated by personal or interpersonal goals. We tested a process that linked culturally shaped self-construal to the postsuicidal personal and interpersonal well-being. We posited that this process would operate through the attitudes towards suicide, motives for suicide, the strength of the intention to die. Our model indicated that the acceptability of suicide was positively associated with escape motives, and this association was even stronger for the individuals with interdependent self-construals. Escape motives were negatively associated with postsuicidal personal and interpersonal well-being, but communication motives were not associated with these outcomes. We also found evidence that having an interdependent self-construal might be beneficial for postsuicidal personal and interpersonal well-being. Our results further suggested that the postsuicidal personal and interpersonal well-being of highly interdependent individuals may depend on the interpretation of their act of suicide by their close others.

Characteristics of suicide attempts associated with lethality and method: A latent class analysis of the Military Suicide Research Consortium

While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n = 2643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.

How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts

Despite well-documented disparities by sexual and gender minority (SGM) status in suicide attempt and mortality rates, few studies have investigated the lived experiences that contribute to SGM people's disproportionate risk of suicide. Having a history of at least one near-fatal (or medically serious) suicide attempt serves as a proxy for suicide mortality, but no known study has involved SGM people who have made such an attempt. Ideation-to-action theories of suicide posit that individuals acquire the capability for suicide through repeated exposure to painful and provocative events – namely, traumatic, threatening, and risky experiences – that can diminish the pain and fear of death. Yet whether identity-specific features of acquired capability for suicide contribute to SGM people's disproportionate risk of suicide remains unknown. Drawing upon interviews with 22 SGM people who experienced a recent near-fatal suicide attempt, the current study sought to identify specific determinants of how SGM individuals acquire the capability to kill themselves, a potentially powerful, and modifiable, pathway to suicide. Results identified three SGM-specific contributors to the acquired capability for suicide: (1) identity invalidation during developmentally sensitive periods of childhood and adolescence that left participants feeling erased, invisible, and, in some cases, non-existent; (2) normalization of suicide within SGM social networks that increased acceptability and reduced the fear of suicide; and (3) structural stigma and SGM community trauma as habituating sources of pain that engendered feelings of exhaustion and positioned suicide as a reprieve from pervasive anti-SGM norms. This study demonstrates that dominant suicidology theories might need to be refined to account for the stigma-related determinants of SGM suicide. Further, this study reinforces the importance of qualitative methods for understanding the lived experience of suicide and calls for SGM-specific suicide prevention efforts to respond to stigma to support those SGM people who contemplate suicide.

Predictors of Caregiver Burden Among Carers of Suicide Attempt Survivors.

Background: Family members often provide informal care following a suicide attempt. Carers may be vulnerable to caregiver burden. Yet, little is known about what contributes to this. Aims: To determine the predictors of caregiver burden in those carers who support people who have attempted suicide. Method: An online survey of 435 participants assessed exposure to suicide, caring behaviors, and psychological variables and caregiver burden. Results: A multivariate model explained 52% of variance in caregiver burden. Being female, closeness to the person, impact of suicide attempt, frequency of contact pre-attempt, and psychological distress were positively associated with caregiver burden. Confidence in supporting the person after suicide attempt, perceived adequacy of healthcare the person received and the support the carer received, and suicidal ideation of the carer were negatively associated with caregiver burden. Moderation analysis suggested that carers with high levels of distress reported negative association between suicidal ideation and caregiver burden. Limitations: The cross-sectional online survey design of self-identified carers is a limitation of the study. Conclusion: Carers are highly distressed, and if unsupported report increased suicide ideation. In their caring roles they may have contact with support services, thus attending to their needs may ameliorate caregiver burden and associated negative outcomes.

Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived

To what extent does a suicide attempt impair a person’s future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.

Suicide by hanging: A scoping review.

Suicide by hanging is increasing in many countries around the world and whilst efforts are being made to influence the prevention agenda to reduce the incidence, little is known regarding the contributing factors for choosing this method. The purpose of this scoping review is to summate understandings about how the epidemiology and prevention of suicide by hanging is recognised, described, and discussed in the literature, and critically appraise the extent to which the lived-experiences of survivors of suicide attempts are included. A scoping review was conducted implementing the appropriate framework and in accord with the PRIMSA-ScR extension. Three databases (CINAHL, PubMed, and PsycINFO) were searched along with the reference lists of eligible sources in January and February 2021. Thirty-six articles with a primary focus on hanging as a method of suicide and/or its prevention are included in this review, with brief thematic analysis used to summarise the featured studies. Three distinct themes emerging from the literature include: (i) Hanging suicide deaths in the community environment or person's usual place of residence, (ii) Hanging suicide deaths in controlled environments (including police cells, prisons, and inpatient units), and (iii) Medical management of near-lethal hangings. This review highlights the necessity for improving education and policy regarding the controlled environments frequently associated with hanging suicides and the medical management of near-lethal hangings, as well as the ongoing need for policy to guide and govern the responsible media portrayal of known suicides as well as fictional hangings. Finally, this review highlights the necessity for including those with lived-experiences of a suicide attempt by hanging to advance the current prevention agenda.

The context of disclosing suicidality: An exploration with attempt survivors

AbstractSuicide attempt survivors selectively disclose suicidal ideation and suicide attempts. However, little is known about how suicide attempt survivors make these disclosure decisions. To address the dearth of research on the context of suicide disclosure, a community‐based participatory research team analyzed qualitative data from suicide attempt survivors (n = 40) to examine when, how, and to whom they disclose suicidality. We describe findings on three main themes: (1) who to tell, (2) when to tell, and (3) how to tell. Within subthemes, we provide examples of diverse disclosure‐related strategies, including gradual disclosure, adapting disclosure to the audience, and determining the emotional readiness of both discloser and confidant. Counselors can use the study results to aid suicide attempt survivors in making disclosure decisions and crafting disclosure messages that maximize benefits for suicide attempt survivors and those to whom they disclose.

Deep wrist injuries from suicide attempts vs. accidents do not differ regarding sensorimotor outcome, but regarding patient-reported outcome measures

Despite the clinical importance of deep wrist injuries (DWIs), data comparing the outcome of suicide attempt survivors vs. accident survivors are lacking. Patients admitted to our Clinic for acute treatment of a DWI from 2008 to 2016 were contacted for a follow-up assessment of sensory, motor and functional outcomes. Patients also completed the Disability of the Arm, Shoulder and Hand Questionnaire, the Modified Mayo Wrist Score, the Boston Carpal Tunnel Questionnaire, and the WHOQOL-BREF questionnaires. 51 patients could be followed up, on average 4.3 ± 2.9 years after their injury. Suicide attempt survivors did not differ from accidents survivors concerning two-point discrimination, grip and pinch strength, but showed poorer outcomes in self-reported disability, symptom severity, and quality of life. Patients with DWIs from suicide attempts vs. accidents do not differ in sensorimotor outcomes but patient-reported outcome measures. Level of Evidence: II

“Maybe Jesus Was Suicidal Too”: A United Church of Christ Pastor Reflects on His Suicide Attempt

Research has long demonstrated that people who are religiously involved tend to be more shielded from suicide than those who are not, yet it has been less attentive to the conditions under which religiosity fails to inhibit suicidality. Since Durkheim’s 1897 Suicide investigated the link between religious affiliation and suicide rates, most of the related research has also taken a broadscale sociological approach, used simplistic measures of religiosity, and ignored spirituality. Virtually absent are more penetrating idiographic investigations into suicidal individuals’ lived experiences of religion and spirituality. This article aims to rectify that by presenting a qualitative study of eight suicide attempt survivors in the US. The complex convergences of religion/spirituality and suicidality in their lives are discussed. Religion and spirituality did palliate the participants’ suicidality, but only after their suicide attempts; prior to the attempts, religious factors aggravated and even induced suicidal urges. During the suicide attempts, meanwhile, religion and spirituality were inconsequential. The story of one participant, an ordained minister in the United Church of Christ, is highlighted to illustrate the findings. Recommendations for further research and suggestions for spiritually integrated approaches to care encounters with suicidal individuals are given.

Self-inflicted injury and the older trauma patient: a 20\xa0year review of suicide attempts and outcomes

Key summary pointsAimTo describe a cohort of older trauma patients treated for injuries related to intentional injury over 20 years.FindingsIntentional injury among older patients is rare, but differences are evident when comparing older and younger survivors of suicide attempts. Differences with mortality method of self-inflicted injury, discharge to home and injury severity between genders were identified.MessageAlthough older patients are not the typical suicide attempt patient presenting at hospitals, their management and discharge planning are often complex and challenging due to undiagnosed mental health conditions, pre-existing comorbidities and difficulties with mental health resource options for this age group.

Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor

One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.