Suicidal Intent Research Articles

Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States.

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than one to 100%, with a mean of 29.6 +/- 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that pre-admission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at-risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the U.S..

Severe intoxication after yew (Taxus) ingestion-case report and literature review

Severe yew (Taxus) intoxication is a rare condition that can lead to life-threatening cardiac arrhythmia. The survival of patients requires highly specialized emergency and intensive care treatment. Systematic overview of the clinical picture and important treatment options. Case report of severe yew intoxication with subsequent literature review of comparable case reports. Analysis of 33case reports with a total of 37critically intoxicated patients from the years 2000-2024 from Europe and North America. Severe yew intoxications were almost exclusively the result of suicidal intent. Patients average age was 33 (± 14.5) years. The use of antiarrhythmic drugs and electrical stimulation of the heart often proved to be ineffective or deteriorating in its effect over time. The use of lipid emulsion and/or digoxin-specific Fab fragments has little evidence. The average duration of a clinically relevant arrhythmogenic effect was 22±11.7h. The management of yew intoxication is primarily limited to symptomatic treatment. The availability of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a "bridge-to-recovery" concept appears to be of utmost importance.

Current evidence on the use of sugammadex for neuromuscular blockade antagonism during electroconvulsive therapy - a narrative review.

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ- cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

A study protocol of the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP) for recent suicide attempters: a randomized controlled trial

BackgroundGiven the limited research focusing on psychotherapeutic interventions for suicide attempters, it is noteworthy that the Attempted Suicide Short Intervention Program (ASSIP) has demonstrated promising results in previous studies. In this investigation, we aim to evaluate the effectiveness of ASSIP across diverse healthcare settings, outlining the study design and planned evaluation.MethodsUsing a Randomized Controlled Trial (RCT) design with four assessment points (baseline, 3, 12- and 24-month follow-up), we aim to assess the effect of the 3-session psychotherapeutic intervention and hereafter brief contact via structured letters during 2 years in a clinical sample of recent suicide attempters (suicide attempts within three months before inclusion). Participants are randomly assigned to one of two groups; treatment as usual plus ASSIP or the control condition, treatment as usual. Assessments include measures of suicidal intent, coping, symptoms of depression, quality of life, self-stigma, and sick leave. The primary outcome is suicide attempt(s) within 3, 12, and 24 months and the secondary outcome is suicidal ideation within the same time frames after study inclusion.DiscussionFindings from this study will provide novel insights regarding the effects of ASSIP on not only subsequent suicidal behavior but also other outcomes including self-stigma, quality of life, social network, sick leave, and symptoms of depression.Trial registrationThe trial was registered at ClinicalTrial.gov NCT04746261 on 2020-10-15.

Changes in suicide literacy and intentions to ask about suicide: “Community Linker” training for those supporting Aboriginal people

ObjectiveGatekeeper training programs are widely used with promising results for suicide prevention. However, studies have found that when delivered to Indigenous communities, outcomes can be variable or ineffective. This study is a feasibility trial of a gatekeeper program based on the standardised ‘Question, Persuade and Refer’ (QPR) approach, which was adapted to the cultural needs of local Aboriginal communities in the Shoalhaven region of New South Wales, Australia. The study aims to identify whether 1) knowledge of suicide and intentions to help increase over the course of completing the gatekeeper program; 2) participants of different educational backgrounds have similar outcomes in suicide literacy and intentions to help; and 3) Aboriginal people and non-Aboriginal people have similar outcomes. MethodsOne hundred individuals participated in the research, of which 50% identified as an Aboriginal person. Pre- and post-training questionnaires assessed whether participants experienced an increase in suicide literacy and intentions to support others at risk of suicide. ResultsAlthough pre-test scores for suicide literacy and intentions to help were high, these increased significantly from pre- to post-test. Those with no prior gatekeeper training showed larger changes in both suicide literacy and intentions to ask about suicide compared to those with prior training. ConclusionOverall, this study highlights that delivery of culturally adapted gatekeeper training is associated with improved suicide literacy and intentions to ask about suicide amongst trainees.

Identifying latent classes of suicidal ambivalence: Associations with suicide risk correlates and outcomes.

Research has largely conceptualized suicidal ambivalence as the difference between one's wish to live and wish to die without fully considering other suicide ideation (SI) experiences included on measures like the Beck Scale for Suicide Ideation (BSS). We utilized BSS items to identify SI latent classes and examined relevant correlates and outcomes. We collected self-report data from two samples of US adults who: (1) self-identified as LGBTQ+ (N = 349; cross-sectional) and (2) self-reported past-week SI (BSS score ≥ 11; N = 133; 3 timepoints). Latent class analyses supported three-class (Sample 1) and four-class solutions (Sample 2), which included ambivalent classes. In Sample 1, sexual orientation, gender, depression, anxiety, SI, and suicide-specific rumination were concurrently associated with class membership. In Sample 2, depression, SI, suicide-specific rumination, and physical/psychological distance from suicide methods were concurrently associated with class membership. In Sample 2, at both follow-ups, suicide plans/preparations and Acute Suicidal Affective Disturbance symptom frequencies were provided by class membership, and suicidal intent significantly differed by class membership. SI classes differed by sample and evidenced nuances in SI and suicidal ambivalence. Risk factors and suicide-related outcomes also differed by class membership. Implications and limitations are discussed.

Unintentional nonsuicidal self-injury in an adolescent with perfectionism

Nonsuicidal self-injury typically involves deliberate harm without suicidal intent; however, rare cases exist where self-injury occurs unintentionally, without conscious awareness. This report presents the case of a 16-year-old boy who exhibited unintentional self-harm during sleep, associated with severe academic stress and perfectionism. Despite psychological and medical interventions, the behavior persisted until academic stress was alleviated. This case highlights the need for a differentiated clinical approach to managing unintentional self-harm, emphasizing the importance of stress management and psychological support in adolescents to address the underlying emotional and behavioral triggers.

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

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

Unraveling the Spectrum of Deliberate Self-harm and Survivors of Suicide

Abstract Introduction: Among people who attempt suicide, some may have intent to die and some may not. At present, there are not many studies that have compared clinical profiles based on the intent of the attempt of suicide, i.e., low-intent group (deliberate self-harm [DSH]) and high-intent group (suicide survivors). Our study aims to compare the psycho-socio-demographic profile between DSH and suicide survivors. Materials and Methods: It was a cross-sectional study. A total of 100 patients were recruited for the study. The data were collected on sociodemographic variables, psychiatric disorders, suicide intent, anxiety, and depression. Grouping was done using Beck’s suicide intent as the determining dimension. The DSH and suicide survivors were defined by the psycho-socio-demographic characteristics of the patients. Results: Two groups with different traits emerged in aspects of age, gender, education, occupation, employment, residence, method of attempts, family history of suicide, physical illness, psychiatric diagnosis, well-being, hopelessness, depression, and anxiety scores, which showed statistically significant difference (P < 0.05) in the study. Conclusions: DSH and suicide survivors exhibit notable distinctions in their psycho-socio-demographic and clinical profiles.

Navigating suicidality: swedish social workers’ approaches to identifying and supporting suicidal clients

ABSTRACT This study examines how Swedish social workers across various social work agencies identify and support suicidal clients. Thematic analysis of interviews with seven social workers reveals a reliance on strong client relationships and past experiences with suicidal clients. The social workers consistently assess severity of suicidal intent in clients. Despite variations in roles, social workers generally express comfort in dealing with suicidal clients by using intuition, discretion and professional and organizational logics to support suicidal clients in personalized ways. The exercise of professional discretion and interventions varies based on roles, work conditions, and relationships with suicidal clients. Notably, social workers in addiction recovery outpatient care exhibit a high degree of discretionary power, while youth treatment workers in residential care units prioritize continuity of care, involving psychiatry when needed. Case workers often view psychiatry as responsible for decisions about suicidal clients and routinely refer them to psychiatric care.

Use of Emergency Mental Health Dispatch Training by a 9-1-1 Medical Dispatcher Assisting a Caller Expressing Suicidal Intent: A Case Report.

A growing number of individuals with unmet mental health needs in the United States rely on emergency medical services during mental health crises, and 9-1-1 emergency medical dispatchers (EMD) are often a critical lifeline to help. Unfortunately, current industry-standard dispatching protocols and training required for EMD certification largely lack specificity for managing 9-1-1 calls related to mental health emergencies. The purpose of this report is to illustrate the value of additional targeted training for EMDs that enables them to more effectively assist callers struggling with mental illness or suicidal thoughts. We review a 9-1-1 call in which an EMD utilized specific strategies and language learned during a 3-day emergency mental health dispatch (EMHD) training course to assist a middle-aged male who was expressing suicidal intent with a firearm. Key principles and phrasing from the training were used successfully by the EMD to dissuade the caller from self-harm, and he was ultimately safely met by first responders on scene and transported for care. We also share post-call recollections and reactions from the EMD to demonstrate how in addition to reducing risks for callers and their families, EMHD training has the potential to reduce on-scene risks for field responders and may increase confidence and mitigate negative stress responses in EMDs. Emergency medical services systems in the United States should continue to explore enhanced training and protocols to improve care for 9-1-1 callers experiencing mental health crises.

National trends in pediatric drowning — insights from the Israeli Ministry of Health registry-based cohort

This study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health’s administrative databases, covering all children aged 0–17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1–4 years) and teenagers (15–17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020–2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units.Conclusions: Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively.What is Known:• Pediatric drowning represents a significant public health challenge globally, with varying rates.• In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough.What is New:• Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring.• There was a notable increase in drowning incidents during the last 3 years of the study period (2020–2022), coinciding with the COVID-19 pandemic.

Evaluation of Spontaneous Overtime Methemoglobin Formation in Post-Mortem Blood Samples from Real Cases in Critical Storage Conditions.

Nitrite/nitrate poisoning is an emerging problem, with an ongoing escalation of reported self-administration with suicidal intent in several countries. Nitrites toxicity mainly consists of their interaction with hemoglobin (Hb), causing its oxidization to methemoglobin (MetHb). In order to give support to the correct procedures for the analysis of these cases, this study aims to evaluate spontaneous sample degradation and consequent MetHb formation in the typical storage conditions of a forensic toxicology laboratory. Two different types of samples have been used in this study: the first stage of our study consisted of a retrospective analysis of blood samples obtained by judicial autopsies already stored in the toxicology laboratory, collected over four years (2018-2021), while the samples used for the second stage were appositely collected during judicial autopsies. The data obtained by the application of a derivative spectrophotometry method on these samples suggest that there seems not to be a maximum threshold for MetHb formation within which it is possible to state with a sufficient grade of certainty that the concentration of MetHb found is consistent with an ante-mortem formation and is not the result of an artifact due to sample degradation and storage conditions. On the other hand, the results suggest that MetHb formation depends on the time passed between sample collection and analysis, so that a tempestive sample processing, performed as soon as the samples are received in the laboratory, is crucial to obtain the maximum reliability and diagnostic values from the data when MetHb quantitation is necessary.

Suicidal Ideation Among Older Adults in Prison: A Qualitative Study.

Suicide is a serious public health concern, and people who are incarcerated represent a particularly high-risk group. Although research on the suicidality of persons in prison has gained interest in recent decades, the issue of suicide among older adults in prison has been understudied. Therefore, the aim of the present study was to explore the ways in which older adults in prison understood their experiences of suicidal ideation. Interpretive phenomenological analysis was utilized to analyze interviews with 16 incarcerated older adults. The analysis of the findings revealed four themes: (1) Suicide intentions as a control strategy; (2) Suicide intentions as an act of resistance; (3) Suicide intentions as a means of self-redemption, and (4) Suicide intentions in the absence of other choices. Guided by the life course perspective, the findings suggest that suicidal ideation serves as a means of expressing distinct emotional states that may be unique to older adults in carceral environments.

Self-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study

Objective To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care. Design Observational study. Setting A sentinel network of seven emergency primary care centres throughout Norway. Subjects Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021–10/2022). Main outcome measures Contacts due to self-injurious thoughts and behaviours. Results Self-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours. Conclusion Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts. Implications The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel’s limited exposure.

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

A prospective examination of sleep chronotype and future suicide intent among adults in the United Kingdom: A test of the integrated motivational volitional model of suicide

Objectives/backgroundPrior research identified a connection between evening chronotype and suicidality, but the mechanism underlying that connection is not well understood. The Integrated Motivational Volitional (IMV) Model of Suicide may provide a theoretical explanation for this link. The current project includes a three-time point longitudinal survey to examine whether 1) suicide intent likelihood varies across time, 2) chronotype affects suicide intent likelihood prospectively, and 3) defeat and entrapment explain the association between chronotype and suicide intent likelihood. Patients/methodsParticipants (n = 187 UK adults) completed a baseline survey (demographics, chronotype (morning-eveningness; MEQ), defeat and entrapment, and perceived intent to make a future suicide attempt), and follow-up surveys (MEQ and suicide intent likelihood) 3 and 6 months later. ResultsResults indicated that suicidal intent at 6-month follow-up was lower than baseline or 3-month follow-up. It was also found that strong evening chronotype at baseline is associated with increased suicidal intent 6 months later, and that defeat mediates this relationship. ConclusionOur theoretically informed findings shed light on the psychological mechanisms linking chronotype (i.e., eveningness) and future suicide intent by highlighting the role of defeat and entrapment. We propose that feelings of defeat might be derived from evening types’ experiences of social jetlag (resulting from conflict between biologically driven sleep schedules and externally dictated social schedules), which consequently drives entrapment and greater future suicide intent. Within this context, defeat and entrapment may be good transdiagnostic and modifiable target variables for future intervention development.

Follow-Up Care Offers and Acceptance in Crisis Line Suicide Prevention Services.

Background: Prior work has explored the impact of follow-up calls in a crisis line context, but no research has investigated the offer and acceptance of follow-up care. Aims: To identify caller/call characteristics associated with whether a caller is offered and accepts follow-up services. Methods: This cross-sectional study included data from 55,594 callers to a member center of the 988 Suicide & Crisis Lifeline (988) between 2017 and 2019. Logistic regression analyses were conducted to examine associations between caller/call characteristics and two follow-up outcomes. Results: Black callers and those with higher suicide capability and intent had greater odds of being offered and accepting follow-up. Longer call duration was also associated with higher odds of being offered and accepting follow-up. Higher suicidal desire uniquely increased the odds of offers, whereas a higher level of buffers uniquely decreased the odds of offers. Limitations: Data were collected from a single 988-member center and cannot be generalized. Conclusions: That one-third of callers do not accept follow-up highlights the need to understand reasons for not accepting follow-up. That callers with higher risk profiles are offered and accept follow-up at higher rates is reassuring and underscores the benefit of tailoring follow-up interventions for higher-risk callers.

Role of Steroids in Paint Thinner Induced Chemical Pneumonitis

Abstract Paint thinners are organic hydrocarbons that contain a mixture of chemicals such as acetone, toluene, and xylene. Thinner poisoning is most common in children due to accidental ingestion. Acute poisoning can lead to various systemic manifestations such as chemical pneumonitis, arrhythmia, dermatitis, and metabolic acidosis. Chronic toxicity leads to encephalopathy and weakness. Usually, management of chemical pneumonitis following hydrocarbon aspiration is symptomatic and the role of steroids is controversial. We report the case of a 47-year-old female who presented with ingestion of paint thinner with suicidal intention and developed chemical pneumonitis. She was initially managed symptomatically but due to persistent symptoms, was started on intravenous steroids and antibiotic. The patient showed symptomatic and radiological resolution.

Self-poisoning with paracetamol in England: short report of characteristics of individuals and their overdoses according to source of tablets.

Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients' acts on the Beck Suicide Intent scale (BSI). Patients were predominantly female (86%) and young (79% aged 12-24 years). Most had used paracetamol which was available in the home (77%). Those who purchased paracetamol for the act took double the number of tablets compared with those who used paracetamol available in the home (37 v. 18), had higher suicidal intent (mean BSI: 11 v. 7) and more often required treatment with N-acetyl cysteine (71% v. 43%). These results highlight the need for safer home storage of paracetamol and consideration of reducing pack size limits on paracetamol that can be purchased.