Likelihood Of Suicide Research Articles

MA19.02 Psychological Distress in Never, Ex, Current, and Passive Smokers Diagnosed with Lung Cancer - Analyses from the EnRICH Program

Lung cancer is associated with greater psychological distress than any other cancer. In Australia, the prevalence of anxiety and depression in those with lung cancer is nearly 30% higher than the average of other major cancers. More than 50% of patients experience distress, anxiety and/or depression, resulting in diminished quality of life (QoL), and a fourfold increase in likelihood of suicide than the general population. Lung cancer stigma, arising from presumption about tobacco exposure and associated smoking stigma, contributes to high levels of distress. A national survey found that more than a third (35%) of Australians believe those living with lung cancer “have only themselves to blame” and almost 40% indicated, before expressing concern, the first question they would ask someone diagnosed with lung cancer is whether they smoked. This stigma makes lung cancer patients reluctant to seek psychosocial support and reduces their sense of entitlement to care and empathy. However, approximately one fifth (21%) are life-long never-smokers. This study aimed to describe differences in levels of psychological distress in never-and ever-smokers enrolled in the Sydney Catalyst EnRICH Program, a prospective clinical cohort of patients with lung cancer in New South Wales, Australia. Measures: EnRICH incorporates patient-reported outcome measures (PROMs) that assess dimensions of anxiety, depression, emotional function, and psychological distress, namely, the: (i) EORTC QLQ-C30; and (ii) NCCN Distress Thermometer. Sample: All patients with newly diagnosed lung cancer presenting to study hospitals are eligible for the EnRICH cohort. Consenting patients who completed PROMs comprise the sample for the current analyses. Statistical Methods: Subscales of the QLQ-C30 reflecting overall QoL and emotional function, and scores on the NCCN Distress Thermometer, were compared between patient groups by smoking status. Groups were combined into never-smokers (never, passive) and ever-smokers (ex, current) for analyses. Mean differences and 95% confidence intervals were computed. Among 205 patients who completed PROMs (69% of consenting patients), there were 52 never-smokers, 5 passive-smokers, 161 ex-smokers and 52 current-smokers at the time of diagnosis. Emotional function was worse in never-smokers (ever=75.3, never=63.2, difference=12.1 points 95%CI 2.4-21.7). There were no differences in other subscales. Although numbers are small, passive-smokers had the lowest mean scores for emotional-, role-, and social-functioning (Figure 1). Distress thermometer scores were 1.2 points worse in never-smokers [95%CI (0.56-1.8)]. Never-smokers had worse emotional function and higher distress than other lung cancer patients. If confirmed in larger studies, additional supportive care services may improve outcomes for these patients.

The role of depression in unnatural death: A case-based retrospective study

BackgroundDepression affects the life of millions around the globe and perhaps also the manner of death. This study examined the role of depression in specific causes of unnatural death and whether alcohol and substance use affect this relationship, in one locality in Scotland. MethodsThe research used a retrospective case-based study approach to analyse 168 cases, quantifying data reported in mortuary files to allow for quantitative statistical analysis of associations and differences amongst the variables. ResultsA diagnosis of depression was associated with a higher likelihood of unnatural death due to suicide, drugs or homicide. A diagnosis of substance abuse was associated with a diagnosis of depression and with an increased likelihood of death due to suicide or drugs. A diagnosis of alcohol abuse was associated with a reduced likelihood of a diagnosis of depression but was associated with an increased likelihood of suicide. LimitationsThis study relied on a small sample from one locality in Scotland which limited the ability to generalise the results and the retrospective case-based design also limited the potential for checking data accuracy or to consider temporal relationships, which limited the ability to interpret causality. ConclusionsThis study found that there was a relationship between depression and unnatural death, which was mediated by alcohol and substance use. The importance of this study lies within the recognition of these relationships which identified the complexities of these relationships but suggested that some unnatural deaths within this population could be prevented.

Impulsivity facets and perceived likelihood of future suicide attempt among patients who recently attempted suicide

BackgroundGiven the substantial heterogeneity of both impulsivity and suicidality, increased specificity in studying relations between these variables is needed. One aspect of suicidality that may be especially important for predicting future risk among those with a recent suicide attempt is self-perceived likelihood of making a future attempt (suicide likelihood). Presently, little is known about the extent to which impulsivity is related to this important aspect of suicidality. We examined whether three distinct impulsivity facets (i.e., deficits in conscientiousness, negative urgency, and sensation seeking) would differentially predict suicide likelihood. MethodsParticipants included 155 psychiatric inpatients who presented to a Level-1 trauma hospital after a recent suicide attempt. Structural Equation Modeling (SEM), in which demographic and clinical covariates were controlled, was conducted to examine whether each impulsivity facet would uniquely predict suicide likelihood. ResultsDeficits in conscientiousness was the only robust predictor of suicide likelihood, with an association that persisted after accounting for demographic and clinical covariates. LimitationsThe cross-sectional design and unknown predictive validity of suicide likelihood are study limitations. ConclusionThis was a preliminary investigation of impulsivity facets with suicide likelihood. Clinical implications of this study suggest that deficits in conscientiousness and suicide likelihood may be important factors to consider when identifying and intervening with patients at high-risk for suicide.

Risk factors and comorbidity of ICD-11 PTSD and complex PTSD: Findings from a trauma-exposed population based sample of adults in the United Kingdom.

Following the recently published 11th version of the WHO International Classification of Diseases (ICD-11), we sought to examine the risk factors and comorbidities associated with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Cross-sectional and retrospective design. The sample consisted of 1,051 trauma-exposed participants from a nationally representative panel of the UK adult population. A total of 5.3% (95% confidence interval [CI] = 4.0-6.7%) met the diagnostic criteria for PTSD and 12.9% (95% CI = 10.9-15.0%) for CPTSD. Diagnosis of PTSD was independently associated with being female, being in a relationship, and the recency of traumatic exposure. CPTSD was independently associated with younger age, interpersonal trauma in childhood, and interpersonal trauma in adulthood. Growing up in an urban environment was associated with the diagnosis of PTSD and CPTSD. High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio [OR] = 21.85, 95 CI = 12.51-38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77-41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81-5.41) and CPTSD (OR = 3.43, 95 CI = 2.37-4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness. CPTSD is a more common, comorbid, debilitating condition compared to PTSD. Further research is now required to identify effective interventions for its treatment.

Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study.

To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.

Chronic obstructive pulmonary disease as a risk factor for suicide: A systematic review and meta-analysis.

Patients living with chronic obstructive pulmonary disease (COPD) commonly present several limitations in their daily activities, high depression rates, and low quality of life, which makes this population a risk group for suicide. This study aims to systematically assess the literature on the association between CPOD and the likelihood of suicide. The protocol was registered in PROSPERO (CRD42018096618). The Latin-American and Caribbean Health Sciences Literature (LILACS), PubMed, SciELO, Scopus, LIVIVO, Web of Science, and PsychNET databases were used as primary study sources. OpenThesis and OpenGrey were used to partially capture the "grey literature". A manual search was also performed through a systematized analysis of the references of eligible articles. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. A random effects meta-analysis was performed to estimate the variation in odds ratio (OR) and 95% confidence intervals (95% CI). The search provided 4762 results, from which only seven met the eligibility criteria and were ultimately included in the qualitative assessment of the review. The studies were published from 2002 to 2015. All studies presented low risk of bias. The total sample included 1390 suicide cases of COPD patients. The meta-analysis, which was based on five eligible case control studies, found that people with history of COPD are more likely to commit suicide (OR = 1.90; 95% CI = 1.27-2.48; p = 0.002). COPD patients are 1.9 times more likely to commit suicide than people without COPD.

The Risk of Suicide and Self-Harm in Adolescents Is Influenced by the "Type" of Mood Disorder.

We sought to examine the extent to which suicidal ideation and self-harm are associated with a set of psychiatric conditions in senior high school students. A total of 1577 students completed an anonymous survey assessing lifetime rates of mood, anxiety, and eating disorders; the extent to which the presence of any depressive condition attracted bullying; help-seeking strategies; as well as rates of self-harm and suicidal ideation and plans over differing periods. Suicidal ideation and plans together with self-harm rates were distinctly higher in those with a melancholic depressive or a bipolar disorder (compared with those with nonmelancholic depression or an anxiety or eating disorder) and generally higher in females, whereas numbers of those with such conditions attending a mental health professional were low. Thus, for those with a mood disorder, the type of the condition appears to have a distinct impact on the likelihood of suicide and self-harm.

Association between socioeconomic attainments and suicidal ideation by age groups in Korea.

Suicidal ideation is a strong antecedent of suicidal behavior, associated with increased likelihood of suicide. Thus, suicidal ideation serves to identify which groups are at more risk of suicide and has policy implications for targeting groups to prevent suicide. A substantial body of research has addressed potential determinants of suicide ideation in Korea. Little attention has been paid, however, to analyzing the extent to which socioeconomic attainments (education, household income, and employment status) are associated with risk of suicidal ideation, drawing on nationally representative data. Data were drawn from the 2012 Korea Welfare Panel Study (KOWEPS). Among the 12,606 respondents, the findings are based on 1,500 young adults (age 18-35) and 3,469 middle-aged adults (age 36-55) who answered a question about suicidal ideation. For young adults, respondents from 2-year and 4-year colleges and higher had lower probabilities of suicidal ideation compared with respondents from high school. People out of the labor force also exhibited an elevated risk of suicidal ideation compared with those in waged employment. Middle-aged adults displayed different patterns. Middle-aged respondents from 4-year colleges or higher had an increased likelihood of suicidal ideation. The likelihood of reporting suicidal ideation was predicted to decrease as household income increased only for middle-aged adults. The information about suicidal ideation was obtained from only one question of self-response, which limits the validity of the suicidal ideation measurement. The cross-sectional setting of the data prevents us from estimating causal relationships. Nevertheless, the findings imply that age-specific policy should be implemented to ameliorate differential risk for suicidal ideation and benefit public mental health in the long run.

Predicting Future Suicide: Clinician Opinion versus a Standardized Assessment Tool.

To compare the effectiveness of clinician prediction of risk to a standardized assessment of presentation status. All adult psychiatry emergency department consults in the two main hospitals in Winnipeg, Canada, were assessed using a standardized form (n=5,376). This form includes two risk scales for a gestalt physician assessment of risk (Suicide Likelihood scale, suicide Attempt Likelihood scale) and the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Regression determined whether assessments predicted future suicide attempts and deaths. The area under the curve (AUC) determined the prediction accuracy of these methods. Although the regression results were significant, the AUCs were either moderate or poor. Clinician assessment was not effective at predicting deaths (AUC=.546, .36-.73), but moderately accurate at predicting future attempts (AUC=.728, .66-.79). C-CASA assessment was moderately accurate at predicting both attempts and deaths (AUC=.666 and .678). Clinician assessment does not significantly outperform a simple assessment of the occurrence of suicidal thoughts and behaviors during presentation to the emergency department. Behavior-based standardized assessments should be further researched in this field. Assessment of suicidality at presentation using C-CASA or similar assessment should be standard for psychiatric patients assessed in the emergency department.

Can Neutrophil Lymphocyte Ratio Predict the Likelihood of Suicide in Patients with Major Depression?

BackgroundNeutrophil lymphocyte rate (NLR), platelet lymphocyte rate (PLR), and systemic immune inflammatory index (SIII) are rates obtained from hemogram parameters, and they are biomarkers used for the diagnoses of many diseases and their severity, and prediction of disease. In addition to the NLR, PLR, and SIII, platelets, plateletcrit (PCT), and platelet distribution width (PDW), which are platelet indices, are also investigated as biomarkers in many diseases. There are limited studies on the use of hemogram derivates (NLR, PLR, and SIII) in the diagnosis and severity determination of psychiatric disorders.ObjectivesIn this study, we aimed to investigate the effect of biomarkers and the proportions of NLR, PLR, and SIII, which are obtained from hemogram parameters, to distinguish or predict the patients with major depression who are likely to commit suicide.Materials and methodsIn this retrospective study, the files of patients referred to an educational research emergency and psychiatric outpatient clinic between June 2017 and December 2017 were evaluated. Patients who had been referred to the emergency polyclinic because of suicide attempts and those with major depression diagnosed at a psychiatric clinic were evaluated in this study. All hemogram evaluations were performed using the Sysmex XT-2000i Automated Hematology Analyzer (GMI, MN, USA).ResultsTwenty-seven suicide patients and 26 major depression groups meeting the study acceptance criteria were included in the evaluation. Of these patients, 40 were female and 13 were male. There was no difference between the groups in terms of age, body mass index, and complete blood count (CBC) parameters such as white blood cell (WBC), neutrophil count, lymphocyte count, eosinophil count, monocyte count, platelet indices, and NLR, PLR, SIII, which were obtained from the hemogram.ConclusionWe found that the neutrophil to lymphocyte ratio and other biomarkers obtained from hemograms were higher in patients with major depression than those who had suicide attempts, but we found that this was not statistically significant.

The Impact of Negative Stimuli on Suicidality among Adulthoods: A Mediating Effect of Depression

ABSTRACTSuicide is the leading cause of mortality in the world. The major factors of suicidal behavior are depressive symptoms. Using data from the Korean General Social Survey conducted in 2012, this study identified the causes of suicidality using general strain theory (GST). The total sample size was 1,396. The results showed that physical punishment and mental abuse experienced in childhood increased the mediating variable, level of depression, in adulthood. This study also found that suicidality was significantly associated with depression level. Furthermore, physical punishment and mental abuse had significantly direct effects on the suicidality. As a result, this study found that negative experiences before 18 years of age have an influence on later depression, which increases the likelihood of suicide. Also, this study strongly supported GST. Therefore, reducing the causes of depression during adolescent period would be a key strategy to decrease suicide risk during adulthood.

Sleep problems and suicidal behaviors in college students

Using a large sample of college students, objectives were to examine (1) the overlap between poor sleep and suicide risk status, (2) whether poor sleep was associated with suicide behaviors above and beyond depression, (3) whether sleep problems and depression interacted to predict increased suicidal behaviors or risk, and (4) which specific components of sleep were uniquely associated with suicidal behaviors. Participants were 1700 college students (ages 18-29 years; 65% female) from two universities who completed measures assessing sleep, depressive symptoms, and suicidal behaviors (Suicidal Behaviors Questionnaire–Revised [SBQ-R], a composite measure including ideation, past attempt, disclosure to others, and future likelihood of suicide that includes a cutoff for determining participants with suicide risk). Approximately one-quarter (24%) of participants were classified with suicide risk. Four-fifths (82.7%) of participants classified with suicide risk also met cutoff criteria for sleep problems; conversely, almost one-third (31.3%) of the participants classified with sleep problems were also classified with suicide risk. Total sleep problems remained significantly associated with suicidal behaviors above and beyond depressive symptoms, though sleep and depression did not interact to predict suicidal behaviors or risk. When considered together and controlling for sex, the odds of being classified with suicide risk were 6.54 times greater for participants with elevated depressive symptoms and 2.70 times greater for participants with sleep problems. Analyses examining specific sleep domains found shorter sleep duration, having bad dreams, feeling too cold while sleeping, and sleep medication use to each be independently associated with suicidal behaviors. Findings add to a growing body of literature linking sleep and suicide in college students.

ПОЧЕМУ РОССИЯНЕ НЕ ХОТЯТ ЖИТЬ?: СОЦИАЛЬНЫЕ ИСТОКИ СУИЦИДАЛЬНОГО РИСКА В ПРИГРАНИЧНЫХ РЕГИОНАХ СТРАНЫ

The relevance of the study is due to the presence in the last decade of a high and ultra-high level of completed suicides in the border regions, which is one third higher than the Russian average. Scientific problems are caused by the absence in the modern Russian society of a sound social control system for this deviation. It is concluded that the increase in the likelihood of suicide depends on the components of social welfare, the realization of which is highly significant on the one hand, and on the other hand it is deprived of a unique combination of objective conditions and subjective dispositions for each region and social subject.

Évolution dans le temps du filicide-suicide masculin au Québec

ObjectivesThe purpose of this study was to specify the number of male filicide-suicide committed in the province of Quebec between 1997 and 2012, and to evaluate whether there has been an increase in the number of male filicide-suicide according to the period studied and the type of motivation to commit the crime. MethodThe data cover all officially registered male filicides committed in the province of Quebec from 1997 to 2012, against youths under 18 years old. A total of 50 cases were divided by five years spans starting in 1997 and analyzed using the Grille d’analyse multidimensionnelle de l’homicide intrafamilial. ResultsThe results show that among the 50 male filicides committed between 1997 and 2012, 13 of these were followed by the aggressor's suicide. Also, the likelihood of suicide committed as a result of filicide is higher among individuals who committed filicide between 2007 and 2012 and who were motivated by marital separation, compared to filicides committed between 1997 and 2001 motivated by another reason. In particular, the majority of perpetrators of filicide committed between 2007 and 2012, motivated by marital separation, committed suicide as a result of the act of committing, compared to individuals who were motivated by another reason for the same period. ConclusionsOn one hand, the present study demonstrates the importance of considering self-destruction and, more specifically, the suicide of these individuals. On the other hand, our study emphasizes the importance of considering the type of motivation to commit filicide, including spousal separation, which is an element of understanding specific to male filicide-suicide.

Psoriasis and suicidality: A systematic review and meta-analysis

Psoriasis is associated with psychiatric comorbidities; however, the relationship between psoriasis and suicidality is not well understood. To perform a systematic review and meta-analysis that elucidates the relationship between psoriasis and suicidality. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched the PubMed, EMBASE, PsycINFO, and Cochrane databases. We searched literature published between 1946 and 2017. We identified 18 studies with a total of 1,767,583 participants, of whom 330,207 had psoriasis. On the basis of random effects modeling, the pooled odds ratio (OR) for suicidal ideation among patients with psoriasis was 2.05 (95% confidence interval [CI], 1.54-2.74). Patients with psoriasis were more likely to exhibit suicidal behaviors (combined attempted and completed suicides) with a pooled OR of 1.26 (95% CI, 1.13-1.40). Subgroup analysis showed that patients with psoriasis were more likely to attempt suicides (OR, 1.32; 95% CI, 1.14-1.54) and complete suicide (OR, 1.20; 95% CI, 1.04-1.39) than those without psoriasis. More severe psoriasis and younger age were associated with greater likelihood of suicidality. There are few studies examining suicidality in conjunction with psoriasis severity. Patients with psoriasis have a significantly higher likelihood of suicidal ideation, suicide attempts, and completed suicides. Among patients with psoriasis, those who are younger and whose psoriasis is more severe are at particular risk for suicidality.

Does prior contact with police reduce the likelihood of suicide? Examining the predictive ability of different incident types and the interaction effects

This study explores the relationship between prior contact with the police as a victim or person at risk and death by suicide. Findings from this study will improve our understanding of the role the police can have in preventing suicide. The sample comprised working age men who died suddenly in New Zealand during 2007–2011. Univariate and multivariate logistic regression models were used to assess the ability of age, ethnicity and prior police contact to predict whether the death was from suicide ( n = 1140) or other causes ( n = 7236). The analysis focused on prior police contact relating to: (1) threatened/attempted suicide, (2) domestic disputes and (3) potential mental health issues. Age, ethnicity and the three prior police contact types all independently predicted suicide. After controlling for demographic variables, prior police contact remained a predictor, with those relating to threatened/attempted suicide having the strongest predictive ability (Adjusted odds ratio [AOR] = 6.05, 4.75–7.70). Importantly, interaction effects were found between prior police contact types. The predictive ability of contact relating to threatened/attempted suicide reduced significantly if the person also had prior contact relating to a domestic dispute or potential mental health issue. Consistent with previous research, the main effects reported in this study suggest that the police have a role in suicide prevention. This study also makes a novel contribution by exploring the interaction effects between types of prior contact. Future research may investigate the interaction effects in more depth to reveal the contributing factors that reduce the odds of suicide.

Suicide Risk and the Economic Crisis: An Exploratory Analysis of the Case of Milan.

In the past five years, several scientific articles have claimed that the increase some countries have registered in suicide rates since 2008 is somehow related to the economic crisis. Other research has suggested that the impact of specific economic problems on the probability of suicidal behavior is often mediated by other individual-level factors, mainly psychological and physical, whose negative influence is exacerbated by reductions in the availability of health and social care during an economic crisis. On the basis of almost 1,000 cases of suicide collected by the Institute of Forensic Medicine in the province of Milan, this article aims at testing whether suicidal probability during an economic crisis is influenced by the interaction between an individual’s employment status and the presence of psychological or physical disease. Using a binary logistic regression model, this article demonstrates that the likelihood of suicide during an economic crisis is three times higher for persons affected by a severe disease, either physical or psychological, than for people who are not affected (OR = 3.156; 95% CI = 1.066–9.339; p = 0.38). Neither employment status nor the interaction between employment status and health status contributed to the difference between the suicide rate before and during the economic crisis.

Suicide risk characteristics among aborted, interrupted, and actual suicide attempters

Few studies have investigated suicide risk characteristics associated with interrupted and aborted suicide attempts. The present study aimed to empirically examine whether assessing a history of interrupted and aborted suicide attempts is valuable when assessing suicide risk, given the relative lack of literature in this area to date. To inform this question, the current study examined differences in risk factors for suicidal behavior among individuals who have carried out a suicide attempt, individuals who report having a history of only interrupted and/or aborted suicide attempts, and non-attempter controls. Approximately 447 undergraduates (M=21.10 years; SD=4.16; 77.6% female) completed measures of carried out suicide attempts, interrupted suicide attempts, aborted suicide attempts, acquired capability for suicide, suicide likelihood, depressive symptoms, suicidal ideation, and non-suicidal self-injury. Results suggest that a faction of individuals endorse interrupted and/or aborted suicide attempts (8.7%), but do not endorse carried out suicide attempts, even in non-clinical samples. Furthermore, results suggest that there are few clinically meaningful differences between those with a history of carried out suicide attempts and interrupted/aborted suicide attempts, suggesting that individuals with a history of these lesser studied suicidal behaviors are an important group to target for suicide risk intervention.

Suicide Prevention in Health Care.

Decreasing suicide rates through health care system change is an example of how improving patient safety warrants psychiatrists’ awareness, training, teamwork, and leadership in system-based solutions. It has been over 15 years since the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System (2), reported that “at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.” In March of 2001, IOM’s next catalyzing report, Crossing the Quality Chasm, concluded that “merely making incremental improvements in current systems of care will not suffice.” These reports inspired the nation’s campaign to improve quality and safety in health care (3). However, adverse events causing morbidity and mortality continue. The Six Sigma comparison of industries ranks the many health care “defects per million opportunities” near that of the Internal Revenue Service tax advice phone-in service; domestic airline flight fatality rates achieve superior Six Sigma safety rates (4). Many of the country’s top sentinel events are mental health related, including restraint-related events, elopements, selfinflicted injuries, and suicides (5). Some of the top sentinel event settings include psychiatric hospitals, psychiatric units, and behavioral health facilities, totaling 19% of all locations for sentinel events since 2004. In comparison, emergency departments account for only 5.4%, and office-based surgery, 0.9%. Approximately 1,500 inpatient suicides occur per year in theUnited States (6). In juxtaposition, themost recent data from aviation fatalities from theNational Transportation Safety Board reveal a total of only 443 aviation deaths (7). If psychiatrists are the pilots of the mental health system, then what can they do in collaboration with others to transform the industry to the next level of safety at a systems level? Many organizations support this system transformation, including IOM, the Agency for Healthcare Research and Quality, the Joint Commission, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. In addition, the American Board of Medical Specialties is highlighting safety standards by integrating patient safety principles into its program for maintenance of certification (MOC) requirements (9). The American Board of Psychiatry and Neurology is part of this leadership drive (10). Focus will begin attending to MOC safety requirements and providing a review of current clinical safety practice. Patient safety is a vital function of psychiatric services and a core objective of the mental health system. Without safety, there would be neither treatment nor recovery. Suicide is one of the top safety challenges that our health care system faces. Psychiatrists and other mental health clinicians practice standards of care in their provision of suicide risk assessment, risk management, and biopsychosocial treatments. However, in the system of care some failure modes are root causes of suicide and are beyond the realm of the psychiatrist’s assessment and treatment. If there were board exam questions on suicide data and suicide risk assessment, psychiatrists would readily know the answers (noted at the end of this column):

Associations between time in bed and suicidal thoughts, plans and attempts in Korean adolescents

ObjectivesTo examine the hypothesis that respondents with any of three specific sleep patterns would have a higher likelihood of suicidality than those without reports of these patterns in Korean adolescents.SettingData...