Suicide-related Behaviors Research Articles

When the United States says you do not belong: Suicide-related thoughts and behaviors among immigrant young adults varying in immigration legal status.

The number of immigrants in the United States and the risk of suicide among minoritized individuals have increased. Little research has examined the impact of immigration legal status on suicide-related thoughts and behaviors (SRTB), despite theoretical and empirical work suggesting that feelings of burdensomeness and failure to belong (prominent among immigrants) are risk factors. We examined a diverse sample of foreign-born young adults (18-25; N=366). Data collection utilized the Suicide Behaviors Questionnaire Revised and items probing belongingness and immigration status (undocumented/Deferred Action for Childhood Arrivals (DACA), permanent, and citizen). DACA/undocumented status was associated with increased SRTB compared with permanent and citizen categories. Increased SRTBs were associated with reduced feelings of acceptance in the United States, increased deportation fears, and increased fear of being harassed or hurt. Of these belongingness variables, only the interpersonal-not feeling welcome in the United States-partially mediated the risk relation between DACA/undocumented immigration legal status and SRTBs, whereas physical and legal threat, like deportation, did not. Our results highlight the interpersonal nature of SRTB risk in DACA/undocumented immigrants and the need for targeted culture and context-appropriate interventions, as well as advocacy and policy to reduce risk in this historically marginalized population.

Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease.

We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771–4.183)), depression score (OR = 1.163 (95% IC = 1.127–1.200)), and Charlson Index (OR 1.228 (95% IC 1.082–1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.

Complex pain phenotypes: Suicidal ideation and attempt through latent multimorbidity.

Given the relatively high rates of suicidal ideation and attempt among people with chronic pain, there is a need to understand the underlying factors to target suicide prevention efforts. To date, no study has examined the association between pain phenotypes and suicide related behaviors among those with mild traumatic brain injuries. To determine if pain phenotypes were independently associated with suicidal ideation / attempt or if comorbidities within the pain phenotypes account for the association between pain phenotypes and suicide related behaviors. This is a longitudinal retrospective cohort study of suicide ideation/attempts among pain phenotypes previously derived using general mixture latent variable models of the joint distribution of repeated measures of pain scores and pain medications/treatment. We used national VA inpatient, outpatient, and pharmacy data files for Post-9/11 Veterans with mild traumatic injury who entered VA care between fiscal years (FY) 2007 and 2009. We considered a counterfactual causal modeling framework to assess the extent that the pain phenotypes during years 1-5 of VA care were predictive of suicide ideation/attempt during years 6-8 of VA care conditioned on covariates being balanced between pain phenotypes. Without adjustment, pain phenotypes were significant predictors of suicide related behaviors. When we used propensity scores to balance the comorbidities present in the pain phenotypes, the pain phenotypes were no longer significantly associated with suicide related behaviors. These findings suggest that suicide ideation/attempt is associated with pain trajectories primarily through latent multimorbidity. Therefore, it is critical to identify and manage comorbidities (e.g., depression, post-traumatic stress disorder) to prevent tragic outcomes associated with suicide related behaviors throughout the course of chronic pain and mild traumatic brain injury management.

Long-term Effects of the Family Check-Up on Suicidality in Childhood and Adolescence: Integrative Data Analysis of Three Randomized Trials.

This study employed integrative data analysis techniques to examine the long-term effects of the family check-up (FCU) on changes in youth suicide risk using three randomized prevention trials, including one trial initiated in early childhood and two initiated in early adolescence. Data were harmonized across studies using moderated nonlinear factor analysis, and intervention effects were tested using an autoregressive latent trajectory model examining changes in suicide risk across long-term follow-up. Across trials, significant long-term effects of the FCU on reductions in suicide risk were observed, although differences between intervention and control group trajectories declined over time. No moderation of intervention effects was observed by youth gender or race/ethnicity or across samples. While results offer further support for the benefits of the FCU for suicide risk reduction, they also suggest that such effects may wane over time, underscoring the need for continued development of the FCU to enhance longer-term durability of effects on suicide-related behaviors.

Antidepressants in adolescence.

SUMMARYIn adolescence, antidepressants are second-line treatment options after psychological therapy for anxiety and obsessive compulsive disorder. They may be first- or second-line options for severe cases of major depressive disorder.The response to antidepressant treatment is generally good for anxiety and obsessive compulsive disorder, but is less convincing for major depressive disorder. Adolescents who do not respond to an adequate trial of one antidepressant should be referred for a psychiatric opinion.Patients must be monitored for rare but serious adverse effects. These include suicide-related behaviours, switching to mania, and serotonin syndrome.

A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions.

ABSTRACTIntroductionService members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference.Materials and MethodsBarriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress.ResultsVeterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators.ConclusionsResults of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.

Introduction to the PLOS ONE collection on 'Understanding and preventing suicide: Towards novel and inclusive approaches'.

More than 700,000 people lose their lives to suicide each year and evidence suggests that the current COVID-19 pandemic is leading to increases in risk factors for suicide and suicide-related behaviour, in particular among young people. It is widely documented that some sectors of the population are over-represented in the suicide statistics. It is also well established that the pathways that lead someone to a suicidal crisis are complex and differ across regions and sectors of the population; as such a multi-faceted approach to prevention is required. Many of us would also argue that novel approaches, that combine broad population-based strategies with individual interventions, and approaches that capitalise on new technologies and methodologies are also required. For these reasons, when bringing together this collection, we deliberately sought studies that focused upon those groups who are over-represented in the suicide statistics yet under-represented in research. We also called for studies that reported on novel approaches to suicide prevention and for studies that reflected the voices of people with lived experience of suicide, also often unheard in research efforts.

Structural validity of the Persian version of the Suicide Capacity Scale among Iranian college students.

This study was the first step in translating the Suicide Capacity scale (SCS-3) from English to Persian and then determining its structural validity in a sample of Iranian students. The sample consisted of 600 participants selected by the convenience sampling method and answered the questionnaires of the Suicide Behaviors Questionnaire-Revised (SBQ-R) Depressive Symptom Index-Suicidality Subscale (DSI-SS), suicide attempt, and suicidal capacity(SCS-3). The single-group factor analysis suggested that the three-factor model shows the goodness of fit with the data. Suicide capacity is a psychometric tool that can be included in public health studies, health psychology, and empirical research to identify suicide-related behaviors in different populations.

Text Analysis of Suicide Risk in Adolescents and Young Adults.

Suicide is of primary public concern for adolescents and young adults (AYAs) who commonly use social media platforms to express their suicidal thoughts and behaviors. Understanding how AYAs communicate their suicide-related thoughts and behaviors in texts can support early detection of suicide risk from their social media posts. Therefore, this study sought to identify themes relevant to suicide risk in AYAs and explore words or terms used by AYAs when they described suicidal thoughts and behaviors. This secondary data analysis utilized an existing data set collected from 255 AYAs between 12 and 25 years of age, who provided brief descriptions of how they and their peers expressed their experiences of self-harm, suicidal thinking, and attempts. Text analysis was conducted using KH Coder software. Three-step theory of suicide was used to guide a content analysis to explore the key themes from the narratives. A word co-occurrence network with 24 clusters of words was generated from the text analysis. These word clusters were further grouped into pain or hopelessness, connectedness, and capacity to attempt suicide in the content analysis. Six subthemes corresponding to these three themes were identified to provide detailed information: psychological or physical pain, hopelessness, relationship, help seeking, methods, and outcomes. Moreover, several slang terms and acronyms (e.g., Kermit Sewage Slide, KMS) were also identified. The findings of this study, including themes and slang terms and acronyms, are valuable to facilitate the use of terms or phrases within social media texts to identify suicide risk in AYAs.

They Told Me "This Isn't a Hotel": Young People's Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour.

In Australia, the number of young people presenting to the emergency department with mental health concerns, in particular, suicidal behaviour (defined here as suicidal ideation, thoughts, intent and attempts) is increasing. Little is known about the experiences of Australian young people who present to hospital emergency departments with suicidal behaviour. In this qualitative study, we conducted a series of focus groups with 55 young people aged 16–25 years, with a view to developing a framework for youth suicide prevention for Western Australia. The data were analysed using a general inductive analysis approach. We explored the experiences and perceptions of the care and management of 35 young people presenting to Western Australian hospital emergency departments. Participants described a range of negative experiences relating to the emergency department environment, staff attitudes and their treatment by staff. We argue that adapting ED practices and approaches to young people presenting with suicidal thoughts and behaviours based on these findings will result in lower rates of repeated presentations and admissions to hospital and lower rates of suicide attempts and deaths by suicide.

Lessons to be learned: identifying high-risk medication and circumstances in patients at risk for suicidal self-poisoning

BackgroundAlthough the total number of suicides decreased since the beginning of the 1980s, the number of suicide-related behaviors using self-intoxication increased. Therefore, research on the characteristics of individuals committing self-intoxication becomes of growing importance for risk assessments and the development of preventive measures.MethodsIn this prospective, observational, monocentric cohort study, all incoming calls at our Poisons Control Centre reporting suicide-related behaviors through self-intoxication, were analyzed via a standardized questionnaire over 12 months. Both univariate and bivariate analyses were performed.Results1238 cases of deliberate intoxication were included in the study. The majority of cases occurred in the age group between 18 and 44 (n = 607/49%), two-thirds were female (n = 817/66%). The main substances used were antidepressants (n = 420/34%), peripheral analgesics (n = 322/26%) and neuroleptics (n = 282/23%). The majority of patients ingested substances from their prescribed medication (n = 640/82%) with the highest proportion in those aged over 64 years (n = 72/113; 91%, p < 0.001). Substance use was reported for the minority of patients (n = 175/23%). For 704 cases (79%), a psychiatric disorder was documented. Factors associated with recurrent suicide-related behaviors were an underlying psychiatric disorder (OR = 6.2; 95% CI 3.8–10.4), substance use (OR = 2.4; 95% CI 1.5–3.8), and ingestion of neuroleptics (OR = 2.1, 95% CI 1.4–3.0) or antidepressants (OR = 1.6; 95% CI 1.2–2.3).ConclusionThis study might contribute to identifying individuals with an increased risk of suicide-related behaviors by deliberate intoxication and to developing preventive strategies for future suicide attempt(s).

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system: A global systematic review.

SummaryBackgroundPeople who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.MethodsWe searched Embase, PsycINFO, MEDLINE, and grey literature databases for articles published between 1 January 2000 and 1 June 2021. The protocol was registered with PROSPERO (CRD42020185989).FindingsThirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.InterpretationMore high-quality evidence from criminal justice settings other than adult prisons, particularly from low- and middle-income countries, should be considered a priority for future research.FundingThis work was funded by the Australian government's National Suicide Prevention Taskforce. RB is supported by a National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant (EL2; GNT2008073). MW is supported by a NHMRC Postgraduate Scholarship (GNT1151103). SF was funded by the NIHR HTA Programme (HTA Project:16/159/09).

Contextualizing Black Women's Mental Health in the Twenty-First Century: Gendered Racism and Suicide-Related Behavior.

Despite predictions from the Black-White and gender paradoxes in suicide risk, there has been a recent growth in suicide rates among Black women and girls that requires special attention from social and behavioral researchers. In this review, we demonstrate how and why an intersectional framework is needed to understand and contextualize Black women's mental health and suicide risk. To begin, we outline data and existing literature on Black women's mental health outcomes. Next, we provide insights from intersectional and Black feminist scholars on the uniqueness of Black womanhood and the necessity of centering racism and sexism in studies of Black women. Third, we present clear links between mental health, gendered racism experienced by Black women, and the Strong Black Woman schema which they adopt to navigate society. Fourth, and finally, we discuss practical and scholarly applications for this work. To this end, this research agenda is about advocating for the consideration of psychosocial and sociocultural factors in practice and research on suicide-related behavior.

Risk of Suicidal Events in Youths Taking Atomoxetine Compared with Those on Methylphenidate; An Observational Cross-Sectional Study

Background: Stimulants such as methylphenidate and atomoxetine, a nonstimulant norepinephrine reuptake inhibitor, are approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Associations between the use of methylphenidate or atomoxetine with suicidal ideation and suicide-related behavior have been reported in the literature. The present study aimed to compare the effects of atomoxetine with that of methylphenidate on suicidal ideation and behavior in children and adolescents. Methods: Children and adolescents between 7 to 17 years of age with the diagnosis of ADHD, based on DSM-5 criteria, were included in this observational, cross sectional study. The suicidal ideation was assessed among children and adolescents who have been receiving either atomoxetine or methylphenidate for at least 12 months prior to entering the study. A Farsi version of Positive and Negative Suicide Ideation (PANSI) inventory was applied for the assessment. Differences among age groups, duration of therapy and comparison of positive and negative scores in both genders were analyzed using t-test. In addition, a one-way analysis of variance (ANOVA) was applied to examine the differences in positive and negative scores among different age groups. Moreover, chi-square and Fisher’s exact tests were performed to examine the effects of past history of drugs and other present illnesses on suicidal ideation. P-value of &lt;0.05 was considered as significant. Results: A total of 57 students between 7 to 17 years of age were enrolled in this study. Twenty-eight patients have been taking atomoxetine at doses of 10 to 60 mg/day while 29 were on methylphenidate 7.50-55 mg/day. The mean positive and negative scores in the atomoxetine group were found to significantly differ (P=0.001) from those in the methylphenidate group. No risk of suicidal ideation was detected in the atomoxetine group, while in the methylphenidate group 15 out of 29 patients (51.7%) scored above the cutoff point. In terms of the relationship between suicidal ideation and history of other drugs prior to the current therapy and other concurrent disorders, chi-square test showed no significant difference in methylphenidate group (P=0.100 and 0.500 respectively). This analysis was not considered in atomoxetine group due to the absence of suicidal ideation. Conclusion: The authors of this study suggest that atomoxetine may be a safer choice than methylphenidate for the treatment of ADHD when suicidal ideation is a concern. In this regard, monitoring suicidal ideation and behavior along with family education should be considered in all children and adolescents suffering ADHD.

Individual Factors Underlying Suicidal Behaviors in Patients with Borderline Personality Disorder: A Qualitative Study

Background: Borderline personality disorder (BPD) is associated with a high risk of suicide. Limited information is available on the individual factors underlying suicidal behaviors, especially suicide attempts (SAs), in Iranian patients with BPD. Objectives: This study aimed to analyze the individual factors underlying suicidal behaviors in patients with BPD. Methods: This was a qualitative descriptive study that was conducted from May 2020 to February 2021 in Tehran and Karaj, Iran, on 23 participants, including 14 patients with BPD and seven mental health professionals, as well as two members of their families. The research environment included psychiatric inpatient wards, psychiatric emergencies, and psychiatric clinics. Participants were selected through purposive sampling. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: Data analysis revealed five main themes and 15 sub-themes related to the individual factors underlying the identification and prediction of the risk for suicidal behaviors and SAs. The extracted themes included “psychological pain and loneliness”, “defects in the distinction and integration of emotions”, “unconventional behavior and emotion”, “pervasive incompatibility”, and “breakdown of the self-integrity”. Conclusions: The BPD is a complex and challenging disorder in which patients with BPD usually tend to engage in suicidal behaviors, and with the emergence of individual factors underlying the occurrence of such behaviors, appropriate preventive measures and interventions can be taken to reduce suicide-related behaviors such as suicidal thoughts and planning, as well as SAs.

Social cognition and suicide-related behaviors in depression: a cross-sectional, exploratory study.

To explore the association between social cognition and previous suicide attempts and non-suicidal self-injurious behavior in adults with unipolar depressive disorders. Seventy-two patients undergoing outpatient treatment for unipolar depression were enrolled in this cross-sectional study. Theory of mind was assessed using the Hinting Task and the Revised Reading the Mind in the Eyes Test. Empathy was evaluated using the Interpersonal Reactivity Index. Lifetime suicide attempts and non-suicidal self-injurious behavior were assessed using the Columbia Suicide Risk Rating Scale. Participants with and without these suicide-related outcomes were compared in terms of social cognition. Patients with previous suicide attempts performed worse on the Reading the Mind in the Eyes Test (p = 0.017). Patients with a history of non-suicidal self-injurious behavior were younger (p = 0.005), had a younger age at first depressive episode (p = 0.017), and scored higher on personal distress in the Interpersonal Reactivity Index (p = 0.027). Only personal distress remained independently associated with non-suicidal self-injurious behavior in multivariable analysis (p = 0.038). Among patients with depression, those with previous suicide attempts or non-suicidal self-injurious behavior showed worse social cognition. These results encourage future research on social cognition deficits as clinical markers of suicide-related behaviors and as targets for interventions.

The aftermath of COVID-19 lockdown: Self-harm and suicide-related behavior among children and adolescents admitted to the Psychiatric Emergency Department

The aftermath of COVID-19 lockdown: Self-harm and suicide-related behavior among children and adolescents admitted to the Psychiatric Emergency Department

Preventing mood disorders associated with suicide-related behaviors among small- and medium-sized enterprise workers in Japan

Preventing mood disorders associated with suicide-related behaviors among small- and medium-sized enterprise workers in Japan

Disparities in Suicide-Related Behaviours Across Sexual Orientations by Gender: A Retrospective Cohort Study Using Linked Health Administrative Data

Disparities in Suicide-Related Behaviours Across Sexual Orientations by Gender: A Retrospective Cohort Study Using Linked Health Administrative Data

Toward Understanding of Suicidality in a Spanish Clinical Population: Validation of the European Spanish Version of the Interpersonal Needs Questionnaire

Introduction: Suicidal ideation (SI) represents one of the most prominent predictors of suicidal behavior (SB). The Interpersonal Needs Questionnaire (INQ) was developed from the Interpersonal Theory of Suicide (ITS) to assess the 2 core drivers of SI proposed by the theory. Despite the relevance of suicide-related ideations and ITS, there is a lack of psychometric measures validated in clinical Spanish population that adequately evaluate SI components of ITS. Thus, the main aim of the study was to validate INQ-10 in a Spanish clinical sample including the genuine cultural and linguistic characteristics of European Spanish. Methods: 315 participants were included in the analyses; 149 of them consulted mental health services for the presence of suicide-related behaviors. A series of exploratory and confirmatory factor analyses were carried out to identify the factor solution. Bivariate and multivariate analyses were used to analyze psychometric properties. Finally, sensitivity and specificity properties were explored through receiver-operating characteristic analyses which also provided the cut-off values of the questionnaire. Results: An 8-item version demonstrated a good fit to the 2-factor solution. Likewise, this 8-item version showed good psychometric properties. Sensitivity and specificity indices of the version validated as well as the calculated cut-off points were excellent. Conclusions: The current results demonstrate the utility of an 8-item INQ European Spanish version as a valid measure of the current SI in Spanish clinical population. In addition, the validated form reflects the theoretical framework on which it was built.