Suicidal Individuals Research Articles

Suicidal subtypes, stress responsivity and impulsive aggression

While prominent models of suicidal behavior emphasize the hypothalamic- pituitary-adrenal (HPA) axis dysregulation, studies examining its role have yielded contradictory results. One possible explanation is that suicide attempters are a heterogeneous group and HPA axis dysregulation plays a more important role only in a subset of suicidal individuals. HPA axis dysregulation also plays a role in impulsivity and aggression. We hypothesize subgroups of attempters, based on levels of impulsivity and aggression, will differ in HPA axis dysregulation. We examined baseline cortisol, total cortisol output, and cortisol reactivity in mood disordered suicide attempters (N = 35) and non-attempters (N = 37) during the Trier Social Stress Test. Suicide attempters were divided into four subgroups: low aggression/low impulsivity, high aggression/low impulsivity, low aggression/high impulsivity, and high aggression/high impulsivity. As hypothesized, attempters and non-attempters did not differ in any cortisol measures while stress response differed based on impulsivity/aggression levels in suicide attempters, and when compared to non-attempters. Specifically, attempters with high impulsive aggression had a more pronounced cortisol response compared with other groups. This is the first study to examine the relationship between cortisol response and suicidal behavior in impulsive aggressive subgroups of attempters. These findings may help to identify a stress responsive suicidal subtype of individuals.

Suicide in Schizophrenia: An Educational Overview.

Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.

“The Problem isn’t Yourself Overcoming, it’s Other People Overcoming You:” A Decolonizing Mental Health DSE Curricular Cripstemology Reading of Daniel and Luna’s Intersectional Dis/ability Experiences

This study brings together 2 case studies to interrogate the intersectional experiences of historically marginalized youth at the intersections of power and identity from a decolonizing mental health disability studies in education (DSE) cripstemology approach. Specifically, we analyzed how US schools create normalized meanings of mental health. Daniel was a 1st-generation Mexican American to the United States, bilingual in both Spanish and English, and was labeled with a learning disability and a speech and language impairment. Daniel was born in Pinole, a southwestern major urban city and was in the 8th grade. Luna, a 16-year-old 10th-grader who lived at home with his mother and his stepfather and identifies as an Arab American, was on an individual education program for his disabilities including mild cerebral palsy, apraxia, and dysarthria. Luna identified as a pansexual and transgender individual and experiences depression and suicide ideation. There were similarities and differences between Daniel and Luna’s experiences related to intersectional disability oppressions that were interpersonal and institutional, their identity processes around school contexts tied to their ethnicities, language use, sexuality, and their experiences with colonial mental health hegemony. Our framework created new knowledge for theory, research, and praxis within US schools.

Talking About Suicide: Trends in Christian and Socially Conservative Suicide Decedents

This study examined the relationship between religious affiliation, social policy beliefs, and whether individuals spoke with anyone about suicide prior to suicide death. Two hundred sixty-seven suicide loss survivors reported on characteristics of suicide decedents. Binary logistic regressions found those who identified as socially liberal were more likely to have discussed suicide with the loss survivor or to have told someone else they were thinking about attempting suicide than were those who identified as socially conservative. Follow-up analyses indicated Christian affiliation was only associated with a lower likelihood of having discussed suicide with the loss survivor among older men. Results indicated that specific worldviews may serve as obstacles to suicidal individuals discussing their suicidal thoughts prior to death. As such, the findings indicate that public health approaches to suicide prevention that do not rely on open reporting of suicidal ideation may be vital within such communities.

Early Maladaptive Schemas Are Associated with Increased Suicidal Risk among Individuals with Schizophrenia

Early maladaptive schemas (EMSs) are a dysfunctional cognitive pattern that can result from maladaptive functioning during childhood. EMSs are broad patterns of memories, emotions, cognitions, and bodily sensations related to the self and others. The aims of this study were to evaluate EMSs among individuals with schizophrenia and to evaluate the relations of EMSs and clinical factors (e.g., depression, positive, and negative symptoms of psychosis) to suicidal risk (e.g., current suicidal ideation, lifetime suicide attempts). Eighty-two inpatients with schizophrenia completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicide Ideation (BSSI), and the Positive and Negative Syndrome Scale (PANSS). Individuals with schizophrenia who had attempted suicide (relative to those who had not attempted suicide) had significantly higher EMSs, current suicidal ideation, and a family history of suicide attempts. Logistic regression analysis revealed that the emotional deprivation schema, positive symptoms, and depression were significantly associated with current suicidal ideation. In addition, emotional deprivation was significantly associated with lifetime suicide attempts. These findings suggest that the emotional deprivation schema, positive symptoms, and depression may be related to suicide in individuals with schizophrenia.

Mutuality and the study of suicide: Psychological notions on military suicides in Israeli courts

This article addresses the complementary work of psychological notions and courts in handling suicides occurring in the course of military service. We suggest the category of mutuality between individuals and social settings as an analytic perspective for the study of suicide, illuminating not only how suicide is constructed, but also theorizing the effects of this construction. Our findings rest on content analysis of 34 verdicts on cases of suicide occurring within the Israeli military. In these verdicts, mostly issued to resolve disputes between bereaved parents and state authorities, Israeli courts decided on the causes of death and the responsibilities of the military and state for soldiers’ suicides. Courts base their decisions on the ambiguous psychological concept of suicidal individuals, explaining self-demise as the result of an internal malaise and avoid addressing the coercive circumstances within which Israeli soldiers operate. By conclusively linking self-demise to suicidality, courts produce an idea of death-seeking soldiers, who fail to ensure their own well-being as well as to defend the common good. Courts render the difficulties encountered during military service mental and personal, thereby contracting, standardizing, and individualizing the idea of mutuality between soldiers, families, and state. To explain these repercussions of juridification and psychologization processes, we draw attention to Durkheim’s conceptualization of contractual obligations and non-contractual sentiments. We elaborate on the Durkheimian connection between solidarity and suicide, by highlighting the outcomes of their interrelated management, especially the courts’ shaping of thin mutuality when arbitrating suicide disputes. Adopting psychological reasoning and assessing personal responsibility, courts potentially fail in their constitutive role of discussing matters of collective concerns.

Development and Validity of the Personal Suicide Stigma Questionnaire (PSSQ).

Background: The detrimental consequences of stigma have been recognized in extensive research on mental illness stigma, but experiences of suicide-related stigmatization have not received sufficient research attention. The lack of a simple self-report assessment of personal suicide-related stigma led to the work reported here. Aim: To develop and assess the validity of the Personal Suicide Stigma Questionnaire (PSSQ). Method: The item pool for PSSQ was based on qualitative data and was tested in a community sample of 224 adults (mean age = 32.68 years, 83% female, 92.9% Caucasian) who reported lifetime suicidality. Factor analysis was used for item selection. The Self-Stigma of Mental Illness Scale - Short form (SSMIS-SF) and Suicide Behaviors Questionnaire - Revised (SBQ-R) were used to assess validity of the scale. Results: Following analysis, 16 items, forming three highly interrelated factors (Rejection, Minimization, and Self-blame), were selected for the PSSQ. The PSSQ scores showed predicted relationships with mental illness stigma and suicidality, suggesting its validity. Limitations: The validity of the scale still requires further research in clinical populations. Conclusion: The newly developed PSSQ can be used to assess the levels of suicide-related stigma experiences of suicidal individuals.

Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin

Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.

Critical appraisal of major depression with suicidal ideation

BackgroundRegardless of its nature, suicidal ideation, in the absence of another diagnosis, is quintessentially associated with major clinical depression. Although for the characteristics of being depressed it is reasonable to have some wish to die, there is no real attempt to understanding the suicidal mind. Clinicians are therefore often inclined to consider suicidal ideation a symptom of major depression. Yet, most depressed patients do not die by suicide, and many of them never experience suicidal ideation even in the most severe depressing scenario. At a closer look, when one works with suicidal individual, suicide appears complex and not line with the obsolete medical model. There are often warning signs for suicide, and suicidal individuals experience mental pain as a common denominator of many adverse events.Case presentationA case report of an entrepreneur with no previous psychiatric history describes the process of meditating suicide as a dimension overlapping the depressive disorder. Details of how this 63-year-old male developed high suicide risk are reported, and clinicians are guided into the understanding of suicide risk.ConclusionsNowadays, clinicians are requested to provide an in-depth investigation into the suicidal mind, an assessment adjunctive to the psychiatric evaluation. A phenomenological approach may be the key to unlock the suicidal mind. Clinicians may use such tool in light of the need for the empathic understanding of human suffering as well as a paradigm shift in the care of suicidal individuals.

Current trend of suicide in Sikkim

The State of Sikkim has been witnessing increasing trend in suicide rate in last decade. Studies examining an extent, pattern and causes of suicide in Sikkim are limited and prevalent notion regarding causes of suicide are mostly based on descriptive narration of an individual suicide cases that usually promotes socio-economic factors and drug use disorders. An attempt has been made in this article to examine current trend of suicide in Sikkim, assessed risk factors by analysing published and unpublished available research studies, and highlight suicide prevention responses by East Sikkim.

Safety Planning on Crisis Lines: Feasibility, Acceptability, and Perceived Helpfulness of a Brief Intervention to Mitigate Future Suicide Risk.

The role of crisis hotlines traditionally was limited to de-escalation and service linkage. However, hotlines are increasingly recruited to provide outreach and follow-up to suicidal individuals. Hotlines have the opportunity to not just defuse current crises but also provide brief interventions to mitigate future risk. The Safety Planning Intervention (SPI) is a brief intervention designed to help manage suicidal crises, but its feasibility and effectiveness on hotlines are not established. This study examined feasibility and perceived effectiveness of SPI, as reported by 271 crisis counselors at five centers in the National Suicide Prevention Lifeline network. Counselors were trained to use SPI. Self-report surveys were completed immediately after training (time 1) and at the end of the study, approximately 9months later (time 2). Counselors reported that SPI was feasible and helpful, and was used on both incoming and follow-up calls. Utilization and perceived effectiveness at time 2 were predicted by self-efficacy, feasibility, and helpfulness at time 1. Results are preliminary and limited to counselors' perceptions. Future RCTs should establish efficacy of SPI for crisis callers. The Safety Planning Intervention is a promising approach to reduce crisis callers' future suicide risk that hotline counselors report is both feasible and helpful.

A latent class analysis of health lifestyles and suicidal behaviors among US adolescents

BackgroundPrevious studies have documented the link between individual health behaviors and suicide, but little is known about the influence of health lifestyles on suicide among adolescents. This study aims to identify the unobserved patterns of health behaviors and to examine their associations with adolescent suicidal behaviors to inform screening of suicidality. MethodsData were derived from a nationally representative sample of adolescents (n = 14,506, ages 12–18, 50.9% female) in the national school-based 2017 Youth Risk Behavior Survey. Latent class analysis was performed based on 13 health behaviors related to diet (e.g., frequency of consuming breakfast, fruits/vegetables, soda), physical activity (frequencies of physical activity, sports team participation), sleep, and media use (TV/computers). Suicidal behaviors were measured by three dichotomized variables, including suicidal ideation, plan, and attempts. Multivariate logistic regressions were used to examine associations between identified classes and suicidal behaviors. ResultsFour classes of health lifestyles were identified. Class 1 (23.6%) consistently engaged in health-promoting behaviors, including eating breakfast daily, high intake of fruits/vegetables, physically active, and infrequent use of TV/computers. Class 2 (37.7%) had an irregular diet, moderate exercise, and high computer use. Class 3 (31.8%) had moderate diet, frequent exercise, and moderate sleep. Class 4 (6.9%) had the lowest engagement in health-promoting behaviors. Class 4 had higher odds of suicide plan than Class 1 (OR = 1.50, 95% CI = 1.10–2.05). Notably, Class 2 and 3 were less likely to attempt suicide than Class 1 (OR = 0.74, 95% CI = 0.57–0.95 for Class 2; OR = 0.65, 95% CI = 0.48–0.89 for Class 3). LimitationsDue to the cross-sectional design, no causal inference can be drawn. ConclusionsBoth Class 1 (consistent) and Class 4 (lowest) engagement in health-promoting behaviors were associated with increased suicidal behaviors. Suicide prevention efforts that examine both lifestyles are keys to early detection of suicidal ideation and plans, and prevention of suicide attempts.

Suicidal ideation disclosure: Patterns, correlates and outcome

This study aimed to identify how frequently suicidal individuals disclosed their ideation, assess which sources were perceived to be most helpful and identify correlates of disclosure and source helpfulness. A cross-sectional survey was conducted with 1,616 Australian adults reporting suicidal ideation in the past 12-months. Participants were recruited from social media and reported on their disclosure of suicidal thoughts to formal and informal sources. 39% of participants did not disclose to anyone, while 47% disclosed to an informal source and 42% to a health professional. The responses of psychologists and counsellors were perceived to be the most helpful, while parents and hospital-based health professionals were perceived to be the least helpful. Severity of suicidal thoughts, younger age, and a suicide attempt in the past 12-months were associated with greater likelihood of disclosure, while participants who were younger, linguistically diverse, had greater suicidal ideation or personal stigma were less likely to perceive the response of a GP to be helpful. This study demonstrates that non-disclosure of suicidal thoughts is frequent and that the response received to a disclosure may not always be perceived to be helpful. Further research is needed to identify how best to support individuals who disclose suicide.

The online treatment of suicidal ideation: A randomised controlled trial of an unguided web-based intervention

Suicide is a major public health issue, and treatment of suicidal thoughts may contribute to its prevention. Provision of online treatment of suicidal ideation may reduce barriers that suicidal individuals experience in face-to-face treatment. We therefore aimed at evaluating the effectiveness of a web-based intervention targeting a reduction of suicidal ideation. We carried out a two-arm, parallel-design, randomised controlled trial in the general population in Flanders (Belgium) (registered as NCT03209544). Participants who were 18 years or older and experienced suicidal ideation were included. The intervention group (n = 365) received access to the unguided web-based intervention, and the control group (n = 359) was placed on a waitlist. Assessments were carried out at baseline and at 6 and 12 weeks. Participants reported high levels of suicidal ideation, depression, hopelessness, worrying, and anxiety at baseline. Compared to the control group, participants in the intervention group experienced a significant decline in suicidal ideation, depression, hopelessness, worrying, and anxiety both at post-test and at follow-up. An important limitation of the study was a high dropout rate, in particular in the intervention group. Our findings suggest that the online self-help intervention was more effective in reducing suicidal ideation and suicide-related symptoms than a waitlist control in a severely affected population. It can help in filling the gap between crisis help and face-to-face treatment.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

Proactive Suicide Prevention Online (PSPO): Machine Identification and Crisis Management for Chinese Social Media Users With Suicidal Thoughts and Behaviors.

BackgroundSuicide is a great public health challenge. Two hundred million people attempt suicide in China annually. Existing suicide prevention programs require the help-seeking initiative of suicidal individuals, but many of them have a low motivation to seek the required help. We propose that a proactive and targeted suicide prevention strategy can prompt more people with suicidal thoughts and behaviors to seek help.ObjectiveThe goal of the research was to test the feasibility and acceptability of Proactive Suicide Prevention Online (PSPO), a new approach based on social media that combines proactive identification of suicide-prone individuals with specialized crisis management.MethodsWe first located a microblog group online. Their comments on a suicide note were analyzed by experts to provide a training set for the machine learning models for suicide identification. The best-performing model was used to automatically identify posts that suggested suicidal thoughts and behaviors. Next, a microblog direct message containing crisis management information, including measures that covered suicide-related issues, depression, help-seeking behavior and an acceptability test, was sent to users who had been identified by the model to be at risk of suicide. For those who replied to the message, trained counselors provided tailored crisis management. The Simplified Chinese Linguistic Inquiry and Word Count was also used to analyze the users’ psycholinguistic texts in 1-month time slots prior to and postconsultation.ResultsA total of 27,007 comments made in April 2017 were analyzed. Among these, 2786 (10.32%) were classified as indicative of suicidal thoughts and behaviors. The performance of the detection model was good, with high precision (.86), recall (.78), F-measure (.86), and accuracy (.88). Between July 3, 2017, and July 3, 2018, we sent out a total of 24,727 direct messages to 12,486 social media users, and 5542 (44.39%) responded. Over one-third of the users who were contacted completed the questionnaires included in the direct message. Of the valid responses, 89.73% (1259/1403) reported suicidal ideation, but more than half (725/1403, 51.67%) reported that they had not sought help. The 9-Item Patient Health Questionnaire (PHQ-9) mean score was 17.40 (SD 5.98). More than two-thirds of the participants (968/1403, 69.00%) thought the PSPO approach was acceptable. Moreover, 2321 users replied to the direct message. In a comparison of the frequency of word usage in their microblog posts 1-month before and after the consultation, we found that the frequency of death-oriented words significantly declined while the frequency of future-oriented words significantly increased.ConclusionsThe PSPO model is suitable for identifying populations that are at risk of suicide. When followed up with proactive crisis management, it may be a useful supplement to existing prevention programs because it has the potential to increase the accessibility of antisuicide information to people with suicidal thoughts and behaviors but a low motivation to seek help.

Predicting Imminent Suicidal Thoughts and Nonfatal Attempts: The Role of Complexity

For decades, our ability to predict suicidal thoughts and behaviors (STBs) has been at near-chance levels. The objective of this study was to advance prediction by addressing two major methodological constraints pervasive in past research: (a) the reliance on long follow-ups and (b) the application of simple conceptualizations of risk. Participants were 1,021 high-risk suicidal and/or self-injuring individuals recruited worldwide. Assessments occurred at baseline and 3, 14, and 28 days after baseline using a range of implicit and self-report measures. Retention was high across all time points (> 90%). Risk algorithms were derived and compared with univariate analyses at each follow-up. Results indicated that short-term prediction alone did not improve prediction for attempts, even using commonly cited “warning signs”; however, a small set of factors did provide fair-to-good short-term prediction of ideation. Machine learning produced considerable improvements for both outcomes across follow-ups. Results underscore the importance of complexity in the conceptualization of STBs.

58. Child Abuse, Depression, and Methylation in Myelin-Related Genes

In postmortem brain tissue studies of psychiatrically healthy controls and depressed individuals who died by suicide, with or without a history of severe child abuse, through unbiased genome-wide DNA methylation analyses it was suggested that vulnerability to depression and suicide in individuals with a history of child abuse is mediated by epigenetic changes in the myelin related genes LINGO3 and POU3F1. To test the translational applicability of these postmortem results we examined peripheral markers of LINGO3 and POU3F1 in youth participating in a study examining risk and resilience in maltreated children.

187. Developing Approaches to Identify and Modulate Components of Altered Resting State Default Mode Connectivity in Suicidal Individuals

Neural signatures of suicidal risk may reflect a combination of suicide-specific and non-specific illness related factors, and successful identification of a marker may assist the development of treatments. We examined whether default mode network (DMN) connectivity can be decomposed into components reflecting familial risk for depression and suicidal ideation (SI), and whether DMN connectivity can be modulated using transcranial direct current stimulation (tDCS) via the left ventrolateral prefrontal cortex (VLPFC).

Traumatic Brain Injury and Suicidal Behavior: A Review.

Given the increasing rate of death by suicide in the United States, it is imperative to examine specific risk factors and to identify possible etiologies of suicidal behavior in at-risk clinical subpopulations. There is accumulating evidence to support an elevated risk of death by suicide in individuals with a history of traumatic brain injury (TBI). In this review article, after defining terms used in suicidology, we discuss the associations of TBI with death by suicide, suicide attempt, and suicidal ideation. A model for repetitive TBIs, leading to chronic traumatic encephalopathy, is also discussed as a neuroinflammatory process, with discussion about its possible link with suicide. The review concludes with an overview of interventions to prevent suicidal behavior.