Suicidal Individuals Research Articles

Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey

ObjectivesProblem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors. Study designSecondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional national probability sample survey of 7403 adults living in households in England. MethodsRates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality. ResultsPast year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention-deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR = 2.9, 95% confidence interval = 1. 1, 8.1 P = 0.023). ConclusionsProblem gamblers are a high-risk group for suicidality. This should be recognised in individual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains.

Oxycodone, Hydromorphone, and the Risk of Suicide: A Retrospective Population-Based Case-Control Study.

Opioids have been increasingly associated with suicide, but whether they are independent contributors is unclear. Oxycodone and hydromorphone are commonly prescribed high-potency opioids that can differentially affect mood. The objective of this study was to explore whether oxycodone and hydromorphone are differentially associated with suicide. We conducted a retrospective population-based case-control study in Ontario, Canada, from 1992 to 2014. Using coronial data, we defined case subjects as individuals who died by suicide involving an opioid overdose. Each of these was matched with up to four controls who died of accidental opioid overdose. We ascertained exposure to oxycodone, hydromorphone, and other opioids from postmortem toxicology testing. We used odds ratios and 95% confidence intervals to examine whether opioid-related suicide was disproportionately associated with oxycodone relative to hydromorphone. We identified 438 suicides and 1212 accidental deaths, each of which involved either oxycodone or hydromorphone but not both. The median age at death was 49years and 51% were men. After adjusting for a history of self-harm, psychiatric illness, and exposure to other opioids, we found that oxycodone was more strongly associated with suicide than hydromorphone (adjusted odds ratio 1.59; 95% confidence interval 1.20-2.11). In a secondary analysis, we observed a trend of similar magnitude in which combined exposure to oxycodone and hydromorphone was more strongly associated with suicide than hydromorphone alone (adjusted odds ratio 1.68; 95% confidence interval 0.92-3.09). While preliminary, these findings support the possibility that some high-potency opioids might independently influence the risk of suicide in susceptible individuals.

Characteristics of Suicides and Toxicology in a Cohort of Individuals With Opioid Use Disorder

Suicide in patients with opioid use disorder (OUD) is a complex issue. In addition to accidental intoxications, a higher prevalence of fatal suicides in patients with OUD can be found compared to the general population. In this study, suicides with a diagnosis of OUD documented in the project “Suicides, A National Survey” were extracted from our data bank. Individuals with a diagnosis of OUD in their medical history were compared to other suicides. The analyses included clinical and demographic factors as well as an investigation of suicide methods and toxicology of psychotropic drugs. For the statistical analyses, we applied chi-square tests and calculated odds ratios. Out of 6,495 suicide cases in Switzerland between 2000 and 2010, 215 individuals with a medical history of OUD could be identified. Persons in OUD cases were significantly younger than in other suicide cases (p < .001) and had more frequently a positive history for suicide attempts (p = .02). In addition, persons in OUD cases were more often female (p = .076). Intentional self-poisoning with medication was applied more often in individuals with OUD compared to other suicide methods (p < .001). When self-poisoning with drugs was compared to violent suicide methods, a combination of benzodiazepines with antidepressants was predominantly found. Our study yielded significant characteristics and risk factors for suicides in individuals with OUD. The predominant method of suicide in individuals with OUD was intended self-poisoning by medication. This knowledge is of clinical importance for the monitoring of at-risk individuals with OUD as well as for suicide prevention in this patient group.

Is Individualism Suicidogenic? Findings From a Multinational Study of Young Adults From 12 Countries.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study

BackgroundSuicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. Methods273 young people (13–35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory – II Edition (BDI), and the World Health Organization Quality Of Life scale – Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. ResultsUHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS “Anhedonia” scores, and showed a negative correlation with all WHOQOL-BREF scores. ConclusionsSuicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.

Mental Health Clinicians' Screening and Intervention Practices to Reduce Suicide Risk in Autistic Adolescents and Adults.

Autistic individuals experience elevated risk for suicide ideation, attempts, and deaths. Little is known about how clinicians assess risk or intervene with suicidal autistic individuals. We surveyed 121 clinicians about use of suicide prevention practices with autistic and non-autistic clients. Clinicians reported greater self-efficacy in screening for suicide risk among non-autistic clients (p = 0.01). There were no statistically significant differences in whether they used standardized screening measures or in their reported normative pressure or attitudes towards screening. Clinicians reported similar rates of use of Safety Planning, an evidence-based suicide-prevention strategy, across groups, but greater acceptability for non-autistic clients (p < 0.001). These findings have implications for strategies to increase clinicians' adoption of these tools for autistic individuals.

The Mediator Effect of Meaningfulness on the Relationship Between Schizotypy Traits and Suicidality.

Introduction: Previous studies have found that schizotypy can predict suicide, and that meaningfulness has influential effects on suicidality in the general population. However, it is still not clear whether meaningfulness is associated with suicidality in individuals with schizotypy. The aim of this study was to assess the mediating effects of meaningfulness in the relationship between schizotypy and suicidality.Method: We recruited 2,615 university students (including undergraduates and postgraduates; mean age = 18.35, SD = 0.81; males, 39%) to participate in our study, and used the Meaningful Life Measure (Chinese, revised) to assess their experiences of meaningfulness, the Suicidal Behaviors Questionnaire (Chinese version) to evaluate participants' suicidal thoughts and attempts, and the Schizotypal Personality Questionnaire to examine their personal schizotypal traits.Results: Meaningfulness was found to be inversely related to the other two factors, and schizotypy was positively associated with suicidality. The correlation between schizotypy and suicidality was reduced when meaningfulness was included, which may suggest that meaningfulness can partly mediate this relationship, accounting for 55.47% of the association.Conclusions: Prior research has suggested that assessing meaningfulness could provide more detailed information about suicide risk in individuals with schizotypy. Our study found that improving perceptions of meaningfulness can be an effective intervention in reducing suicide risk among people with schizotypy.

Stress Response in Suicide Attempters with Borderline Personality Disorder: The Role of Behavioral Problems in Childhood

Objective: Suicidal individuals are a heterogeneous population and may differ in systematic ways in their responsiveness to stress. The primary aim of the present study was to identify whether a different pattern of physiological stress response exists among adult suicide attempters with a history of behavioral problems during childhood and adolescence, which earlier studies have related to both decreased activity of the HPA axis and to suicidal behaviors. Method: Seventy-eight participants with Borderline Personality Disorder were assessed using the SCID-II, and completed self-report measures assessing their history of suicide attempts, history of aggressive behaviors, depressive symptoms, history of lifetime abuse and demographics. Participants’ cortisol reactivity was assessed using the Trier Social Stress Test. Results: Analyses indicated that suicide attempters with a history of behavioral problems in youth (n = 30) had a significantly lower response to stress than both suicide attempters without such a history (n = 26) and non-attempters (n = 22), when controlling for lifetime history of abuse. The groups did not differ in basal cortisol. Conclusions: These findings suggest a unique subtype of suicide attempter among those with Borderline Personality Disorder, characterized by a blunted physiological stress response.

God and Guns

Responses to school shootings nationwide have been varied. While prevention and intervention have been a primary focus for many public schools, healing through faith has been less communicated in the public. Many survivors and stakeholders have publicly ridiculed overtly spiritual responses to school shootings&#x0D; that minimize action needed to address the issue, citing that policy change and improved safety precautions in schools are the primary ways in which change will occur. However, multiple recent suicides of individuals who experienced the effects of a school shooting, suggest that healing from trauma should also be a main priority after a school shooting. This study explores the role of faith and religion with trauma intervention in the aftermath of school shootings. The article uses&#x0D; case study data to discuss the methods by which faith can be a resource for healing from trauma after school shootings.

Lateralization of increased density of Iba1-immunopositive microglial cells in the anterior midcingulate cortex of schizophrenia and bipolar disorder

There is increasing evidence from genetic, biochemical, pharmacological, neuroimaging and post-mortem studies that immunological dysregulation plays a crucial role in the pathogenesis of psychoses. The involvement of microglia in schizophrenia and bipolar disorder (BD) has remained controversial, however, since results from various post-mortem studies are still inconclusive. Here, we analyzed the estimated density of microglia of age-matched individuals with schizophrenia (n = 17), BD (n = 13), and non-psychiatric control subjects (n = 17) in the anterior midcingulate cortex (aMCC), a brain area putatively involved in the pathogenesis of psychoses, using ionized calcium binding adaptor molecule 1 (Iba1)—immunohistochemistry. The microglial cells displayed a homogenously distributed Iba1—staining pattern in the aMCC with slightly varying activation states in all three groups. The estimated microglial densities did not differ significantly between individuals with schizophrenia, BD and control subjects. Remarkably, when both hemispheres were investigated separately within the three groups, the density was significantly lateralized towards the right aMCC in schizophrenia (p = 0.01) and—even more evident—in BD subjects (p = 0.008). This left–right lateralization was not observed in the control group (p = 0.52). Of note, microglial density was significantly lower in BD individuals who did not commit suicide compared with BD individuals who died from suicide (p = 0.002). This difference was not observed between individuals with BD who committed suicide and controls. The results, tentatively interpreted, suggest a hitherto unknown increased lateralization of microglial density to the right hemisphere in both psychiatric groups. If confirmed in independent samples, lateralization should be considered in all post-mortem studies on microglia. Density differences between suicide and non-suicide individuals needs further elucidation.

Suicidal Ideation in Patients Experiencing a First-episode Psychosis: Findings From the 2-Year Follow-up of the "Parma Early Psychosis" Program.

Although suicide behavior is relevant in first-episode psychosis (FEP), little is known about suicidal ideation and its longitudinal stability. The aim of this study was (1) to assess incidence rates of suicide attempts, completed suicide, and suicidal thinking in FEP individuals at baseline and over a 24-month follow-up period; (2) to explore any significant association of suicidal ideation with psychopathology at baseline; and (3) to monitor longitudinally suicidal thinking along the 2-year follow-up. Participants (134 FEP patients, aged 13-54years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was also performed. FEP patients showed a 31.3% percentage of suicidal ideation (i.e., BPRS item 4 cutoff score of≥3) and a 2-year cumulative incidence rate of attempted suicide of 11%. No completed suicide was found. In the FEP total sample, suicidal thinking was positively correlated with general psychopathology (especially depression) and negative symptoms. Suicidal ideation is relevant in FEP patients, supporting a routine monitoring of suicide risk during the baseline assessment of adolescents and adults with early psychosis.

Motivations for suicide: Converging evidence from clinical and community samples

Understanding what motivates suicidal behavior is critical to effective prevention and clinical intervention. The Inventory of Motivations for Suicide Attempts (IMSA) is a self-report measure developed to assess a wide variety of potential motivations for suicide. The purpose of this study is to examine the measure's psychometric and descriptive properties in two distinct populations: 1) adult psychiatric inpatients (n = 59) with recent suicide attempts (median of 3 days prior) and 2) community participants assessed online (n = 222) who had attempted suicide a median of 5 years earlier. Findings were very similar across both samples and consistent with initial research on the IMSA in outpatients and undergraduates who had attempted suicide. First, the individual IMSA scales demonstrated good internal reliability and were well represented by a two factor superordinate structure: 1) Internal Motivations and 2) Communication Motivations. Second, in both samples unbearable mental pain and hopelessness were the most common and strongly endorsed motivations, while interpersonal influence was the least endorsed. Finally, motivations were similar in men and women -- a pattern that previous work was not in a position to examine. Taken together with previous work, findings suggest that the nature, structure, and clinical correlates of suicide attempt motivations remain consistent across diverse individuals and situations. The IMSA may serve as a useful tool in both research and clinical contexts to quickly assess individual suicide attempt motivations.

Investigating Google's suicide-prevention efforts in celebrity suicides using agent-based testing: A cross-national study in four European countries.

Google can act as a "gatekeeper" for individuals who seek suicide-related information online (e.g., "how to kill oneself"). The search engine displays a "suicide-prevention result" (SPR) at the very top of some suicide-related search results. This SPR comes as an info box and contains supposedly helpful crisis help information such as references to a telephone counseling service. It remains unknown, however, how Google has implemented the SPR in the especially dangerous context of celebrity suicide for which imitational copycat suicides in vulnerable individuals are most likely. Relying on agent-based testing, a computational social science method, we emulated a total of 137,937 Google searches in April 2019, using both general suicide-related and specific celebrity suicide-related search terms. Given the recently discovered language-based differences in SPR display rates, we held the language constant and focused on German-speaking populations in four European countries. The SPR was never shown in searches for celebrities who died by suicide in all four countries. Furthermore, analyses indicated a digital divide in access to suicide-prevention information with moderately high SPR display rates in Germany and Switzerland, yet with no display in Austria and Belgium. Higher SPR display rates could support global suicide-prevention efforts at virtually no cost by providing preventive information to vulnerable users precisely at the moment when it is apparently needed.

A suicide prevention initiative at a jumping site: A mixed-methods evaluation

BackgroundGap Park in Sydney, Australia has historically been recognised as a suicide jumping site. In 2010–2011 the Gap Park Masterplan initiative implemented a series of suicide prevention measures. This study applied a mixed-methods design to evaluate the effectiveness of the Masterplan in reducing suicides. MethodsData from the Australian National Coronial Information System (NCIS) was examined to compare suicides at Gap Park before and after the Masterplan was implemented. This was complemented with qualitative data from interviews with police officers who respond to suicidal behaviours at Gap Park. FindingsJoinpoint analysis of NCIS data showed a non-significant upward trend in jumping suicides during the study period. A significant upward trend in suicides was seen for females before the implementation of the Masterplan (2000–2010), followed by a significant downward trend from the implementation period onwards (2010–2016) for females: however, a non-significant upward trend for males was observed. Qualitative analysis of police interviews identified six key themes: romanticism and attraction at hotspots, profiles and behavioural patterns of suicidal individuals, responding to a person in a suicidal crisis, repeat attempts, means restriction, and personal impacts on police officers. InterpretationThe mixed-method study provided important insights, suggesting the Gap Park Masterplan has contributed to a reduction in female, but not in male jumping suicides. Further qualitative information from police officers suggested that the safety barriers were not difficult to climb, and may be more of a visual or psychological barrier. However, the effectiveness of CCTV and alarms in the detection and location of suicide attempters was highlighted. FundingLifeline Research Foundation

Self-determination theory and the collaborative assessment and management of suicidality

Purpose The collaborative assessment and management of suicidality (CAMS) is a first-encounter suicide-specific brief intervention that motivates suicidal individuals for voluntary treatment engagement and choosing life. How the intervention works, however, has not been theoretically explained. The purpose of this paper is to explain the effectiveness using self-determination theory (SDT). Design/methodology/approach The paper focuses the theoretical examination on the philosophy of care and the clinical procedures of the CAMS suicide intervention. SDT is used as the theoretical lens of the examination. Findings The underlying philosophy of care and the clinical procedures of CAMS enhance the autonomy, relatedness and competence of the client in the first encounter. The paper proposes that fulfilling these basic human needs results in the intervention outcomes of treatment engagement and choosing life for the time being. Research limitations/implications The research is limited to the examination of the documented clinical procedures and philosophy of care. Further research applying SDT to the design and empirical testing of therapeutic interventions for suicide prevention is warranted. Practical implications Clinicians working with suicidal clients need to empathically address suicidal individuals’ motivation to engage in voluntary treatment and reduce controlling and autonomy-thwarting approaches. Social implications Suicidal behaviour is conventionally considered the manifestation of a mental disorder characterized by limited informed decision-making. The success of CAMS points to the contrary. Despite their suffering, many suicidal individuals make informed decisions about treatment with the support of an empathetic clinician. Originality/value CAMS has not previously been theoretically explained. This paper explains the effectiveness of the intervention in engaging suicidal clients in further treatment through SDT.

Suicide-Related Training, Self-Efficacy, and Mental Health Care Providers' Reactions Toward Suicidal Individuals.

Background: Mental health care providers commonly encounter suicide ideation and suicidal behaviors among their patients despite a frequent lack of adequate knowledge and competence regarding suicide risk management. Aims: This study examined the associations among self-perceived sufficiency of training, self-efficacy, anxiety, and attitudes related to working with suicidal individuals. Method: Participants were 289 mental health care providers who completed a self-report survey. Results: Path analysis results indicated that perceived sufficiency of training was indirectly associated with negative attitudes (i.e., avoidance and discomfort) and cognitive and somatic anxiety about working with suicidal individuals through assessment self-efficacy. Limitations: The current study utilized cross-sectional data, and there were occupational heterogeneity and geographical homogeneity among the mental health care providers sampled. Conclusion: These findings suggest that sufficient suicide-related training focused on risk assessment may decrease mental health professionals' negative and anxious reactions toward suicidal individuals and enhance confidence in suicide risk management.

Group (“Project Life Force”) versus individual suicide safety planning: A randomized clinical trial

One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA's coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, “Project Life Force” (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.

FCC, Congress Close to Designating 988 as Suicide Hotline Number

FCC, Congress Close to Designating 988 as Suicide Hotline Number

Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies.

BackgroundEcological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies.ObjectivesThis systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments.MethodsPubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion.ResultsThe 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person’s history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed.ConclusionsResearch using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.

Can chronic heart disease lead to active suicidal ideation? – A case report of a planned suicide

The link between chronic illness and depression is complex but indisputable. Individuals with depression may resort to suicide to end their suffering, especially if they have an intractable and incurable illness. Evidence suggests that young people with chronic illness are more likely than older individuals to experience concomitant mental illnesses and thus have an increased risk of suicide attempts. Determined suicidal individuals may use either multiple, potentially fatal, methods in a single event or a single, excessively fatal method to ensure that they do not survive. This may happen in cases where an individual attempts suicide for the first time. In these circumstances, determining the cause of suicide is of paramount importance for future risk assessment and prevention. This report describes the case of a patient with known heart disease who self-inflicted multiple, sharp force injuries on his neck and wrists to end his life.