Suicide Risk Assessment Research Articles

Collaboration and consent in decisions to initiate emergency dispatches for suicide risk: A national qualitative study.

This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch. Semi-structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach. Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de-escalation. Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de-escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches.

An Exploration of the Co-Occurrence of Hallucinations and Suicidal Mental Imagery Among Psychiatrically Hospitalised Adolescents at High Risk for Suicide.

Adolescents with psychosis-spectrum symptoms are at particularly high risk for suicide, however, little is known about how suicidal cognitions manifest in this population. Suicidal cognitions can occur as verbal thoughts and/or mental images of suicide, and mental images may be indicative of a higher risk for suicidal behaviours. Suicidal mental imagery could be a salient and important suicide-related risk factor for adolescents with hallucinations in particular, however, the co-occurrence of these phenomena has yet to be studied. In a sample of psychiatrically hospitalised adolescents, we hypothesize that hallucinations will be associated with increased suicidal mental imagery and suicide attempts. This chart review study included data from 219 adolescents admitted to a psychiatric inpatient unit. Adolescents completed an assessment battery probing hallucinations, suicidal cognitions, and suicide attempts. Adolescents with past-month hallucinations had higher rates of past-week suicidal verbal thoughts and suicidal mental imagery, but not suicide attempts, compared to those without hallucinations. Adolescents with hallucinations reported a younger onset of suicidal mental imagery, and they endorsed more frequent imagery. Past-month hallucinations were significantly and positively associated with suicidal mental imagery, beyond the effects of internalising symptoms. Suicidal mental imagery was positively associated with past-week suicide attempts, but past-month hallucinations were not. Our findings indicate that hallucinations are linked to suicidal mental imagery, an important yet under-studied risk factor for suicidal behaviour. These data highlight the need for more research exploring suicidal mental imagery among high-risk adolescents experiencing hallucinations to inform suicide risk assessment and intervention.

Can large language models be sensitive to culture suicide risk assessment?

AbstractSuicide remains a pressing global public health issue. Previous studies have shown the promise of Generative Intelligent (GenAI) Large Language Models (LLMs) in assessing suicide risk in relation to professionals. But the considerations and risk factors that the models use to assess the risk remain as a black box. This study investigates if ChatGPT-3.5 and ChatGPT-4 integrate cultural factors in assessing suicide risks (probability of suicidal ideation, potential for suicide attempt, likelihood of severe suicide attempt, and risk of mortality from a suicidal act) by vignette methodology. The vignettes examined were of individuals from Greece and South Korea, representing countries with low and high suicide rates, respectively. The contribution of this research is to examine risk assessment from an international perspective, as large language models are expected to provide culturally-tailored responses. However, there is a concern regarding cultural biases and racism, making this study crucial. In the evaluation conducted via ChatGPT-4, only the risks associated with a severe suicide attempt and potential mortality from a suicidal act were rated higher for the South Korean characters than for their Greek counterparts. Furthermore, only within the ChatGPT-4 framework was male gender identified as a significant risk factor, leading to a heightened risk evaluation across all variables. ChatGPT models exhibit significant sensitivity to cultural nuances. ChatGPT-4, in particular, offers increased sensitivity and reduced bias, highlighting the importance of gender differences in suicide risk assessment. The findings suggest that, while ChatGPT-4 demonstrates an improved ability to account for cultural and gender-related factors in suicide risk assessment, there remain areas for enhancement, particularly in ensuring comprehensive and unbiased risk evaluations across diverse populations. These results underscore the potential of GenAI models to aid culturally sensitive mental health assessments, yet they also emphasize the need for ongoing refinement to mitigate inherent biases and enhance their clinical utility.

How, Why and When: Nursing Staff's Experiences of Working With Suicide Risk Assessment Instruments.

To describe psychiatric nursing staff´s experiences of working with suicide risk assessment instruments. Around the world, approximately 720,000 people die by suicide each year, of which almost 20% have an ongoing contact with specialist psychiatry during their last month alive. To identify which patients have an increased risk of suicide is a highly important task for nursing staff. Suicidal behaviour is complex and unpredictable. Nursing staff work closely with patients in everyday psychiatric care and often possess unique patient knowledge. These professionals must therefore be able to know when a patient's eventual suicidality requires further attention and efforts. A descriptive qualitative study. Convenience sampling including nursing staff with more than 2 years of experience in specialist psychiatry. The data collection took place through semi-structured interviews and was then analysed according to conventional content analysis. The nursing staff felt that a natural conversation is superior suicide risk assessment instruments and that experience and patient knowledge are the primary factors for facilitating a suicide risk assessment. This meant that some nursing staff rarely used suicide risk assessment instruments, although they sometimes could be a useful support in the conversation and provided a sense of personal security when documenting results. Suicide risk assessment instrument can be significant and helpful in certain cases, but the essential components of a suicide risk assessment consist of a conversation to understand the meaning of suicide from the patient's perspective. Psychiatric nursing staff contributed to this study by sharing their experiences through interviews.

Social Connection and Suicidal Thoughts and Behaviors in the Million Veteran Program Cohort

People with lower levels of social connection are at increased risk for suicidal thoughts and behaviors. This extends to populations at greater risk of death by suicide, including U.S. military veterans. Despite this well-established association, it is unclear which measures of social connection are most useful in identifying veterans who could benefit from intervention to prevent suicide. To this end, we used data from the Million Veteran Program (MVP) to investigate the measures of social connection most strongly associated with suicidal thoughts and behaviors. Our sample included 264,626 veterans who reported on three measures of social connection—marital status, household size, and perceived social support—and were assessed for suicidal thoughts and behaviors using electronic health records. Veterans who were partnered (OR = 0.78, 95% CI [0.76-0.80], p < .001), living with others (OR = 0.71, 95% CI [0.70-0.73], p < .001), or reported higher levels of social support (OR = 0.67, 95% CI [0.65-0.69], p < .001), were less likely to have suicidal thoughts and behaviors. These associations varied by veterans’ age, sex, and era of military service. When combined into a single risk score, lower levels of social connection were associated with greater likelihood of suicidal thoughts and behaviors (β = 1.42, 95% CI [1.40-1.43], p < .001). Social support, particularly positive social interactions, showed the strongest associations with suicidal thoughts and behaviors in elastic net regression models. Common measures of social connection, particularly social support, could be useful in assessing suicide risk and treatment needs for veterans.

The Interrelationship of Benefit Finding, Stigma, and Suicide Risk Among Patients with Schizophrenia and Their Caregivers: A Six-Month Follow-Up Study.

This study aimed to assess the dyadic dynamics of benefit finding, stigma, and suicide risk on the depression severity of individuals with schizophrenia and their caregivers. We prospectively recruited a total of 72 individuals with schizophrenia and 72 caregivers of individuals with schizophrenia from a medical center in Taiwan between August 2022 and July 2023. Patients with schizophrenia and their caregivers were assessed using the Taiwanese Depression Questionnaire, Benefit Finding Scale, Explanatory Model Interview Catalogue, Suicide Assessment Scale, and Mini International Neuropsychiatric Interview. The most prevalent psychiatric diagnoses in the caregivers were depressive disorders (29.2%). Using structural equation modeling, we found that patients' suicidal risk (β = 0.45, p < 0.001) may contribute to the severity of depression in individuals with schizophrenia. We also found that caregivers' BF degree (β = -0.25, p < 0.01) and suicidal risk (β = 0.64, p < 0.001) may contribute to the severity of depression in the caregivers of individuals with schizophrenia. Furthermore, we found that caregivers' suicidal risk (β = 0.28, p < 0.05) and caregivers' stigma (β = -0.31, p < 0.01) level may contribute to the severity of depression in individuals with schizophrenia. Clinicians should actively manage caregivers' stigma and provide positive reinforcement for caregivers' BF, as this may help reduce depression in both caregivers and individuals with schizophrenia. Additionally, assessing suicide risk in both groups is essential for preventing suicides among individuals with schizophrenia and caregivers alike.

Single Question for Screening Suicide Risk in Patients With Cancer in Nursing Routine Work: A Retrospective Cross-Sectional Study.

To examine the efficacy of the Single Suicide Question, a tactful single-item tool, in assessing suicide risk among cancer patients. Suicide risk screening in cancer patients faces challenges such as cultural, the degree of attention given and the complexity and diversity of assessment methods. An efficient and simple suicide screening tool is needed within the nursing and treatment process. A retrospective cross-sectional study. All data utilised in this study were obtained from assessments conducted by researchers at our institution between March 2018 and August 2023. Retrospectively analysed Single Suicide Question scores from 9703 patients (March 2018-August 2023), with 229 undergoing additional using other established tools (the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Distress Thermometer) alongside the Mini International Neuropsychiatric Interview Suicidal Subscale (MINI Suicidal Subscale). These 229 patients were divided into the cut-off determination dataset (174/229) and the validation dataset (55/229) to analyse, validate and compare the screening efficacy, consistency and optimal cut-off points of the tools relative to the MINI Suicidal subscale (golden standard). K-fold cross-validation was employed to assess the stability of the Single Suicide Question and to revalidate its screening efficacy. In cut-off determination dataset, the Single Suicide Question exhibited good screening efficacy and substantial agreement relative to the MINI Suicidal subscale, as validated in the validation dataset, outperforming other tools. The optimal cut-off points of Single Suicide Question for screening moderate or higher and high suicide risk as 2 and 3 respectively. Its stability in K-fold cross-validation further supported its screening efficacy. The Single Suicide Question shows potential as a preliminary screening tool for suicide risk. Furthermore, it has also demonstrated the potential of a simple, tactful, culturally fitting question in assessing suicide risk, providing insight for the development of relevant tools in different cultural and linguistic backgrounds. Our study demonstrates the potential of the Single Suicide Question as a screening tool for identifying suicide risk among cancer patients, which may facilitate efficient suicide screening. Furthermore, it reveals that tactful, culturally fitting, yet simple tools can achieve good screening efficacy, providing insights for the development of similar tools in different cultural and linguistic contexts. This study investigated the effectiveness of using a culturally contextualised, specific single question to screen for suicide risk in Chinese cancer patients, demonstrating high screening efficacy and stability. With further research, this method may provide a tactful, culturally informed and efficient suicide screening approach to address the critical issue of suicide risk in cancer care, and it also serves as a reference for developing similar tools in diverse cultural and linguistic contexts. The study followed the STROBE checklist guidelines for cross-sectional studies. The data provided by patients were the foundation of this study. Nurses played a central role in conducting the majority of assessments and contributing to the research design in this study.

Artificial intelligence in suicide prevention: Utilizing deep learning approach for early detection

ABSTRACT Background: Suicide among students is increasing in India and is a matter of grave concern. Early identification of students contemplating suicide would facilitate emergency intervention and may save precious lives. Aim: Our primary objective was to construct an artificial intelligence (AI) model employing an artificial neural network (ANN) architecture to predict students at risk of suicidal tendencies. This initiative was prompted by the necessity to implement a proactive and technologically driven strategy for identifying competitive exam-bound students facing heightened vulnerability. The aim was to facilitate timely interventions aimed at reducing the risk of self-harm. Materials and Methods: An AI model utilizing ANNs is devised for suicide risk prediction among exam-stressed students. A 33-feature input layer is curated based on literature and expert insights, with binary features assigned weighted values. A rigorous hyperparameter optimization approach using the Optuna library to select the most effective neural network model. Ridge regression was used to determine bias or variance in the dataset. Training and testing of the model are conducted using fictional and simulated profiles, respectively, and model performance is assessed through statistical metrics and the Cohen’s Kappa coefficient, benchmarked against expert evaluations. Result: The AI model demonstrates exceptional predictive capabilities for suicide risk assessment among competitive exam students. Quantitative Metrics: The model’s accuracy of 98% aligns predictions with outcomes, distinguishing risk categories. Precision at 100% identifies cases within predicted risks, minimizing false positives. A recall of 97% identifies true risk cases, highlighting sensitivity. F1 Score: The model’s F1 score of 98% balances precision and recall, indicating overall performance. Cohen’s Kappa: With a coefficient of 1.00, the model’s substantial agreement with experts underscores its consistent classifications. Conclusion: The study introduces an AI model utilizing ANNs for suicide risk prediction among stressed students. High precision, recall, and accuracy align with expert evaluations, highlighting its promise for timely risk identification. The model’s efficiency in evaluating large populations swiftly indicates its clinical potential. Refinement and real-world validation remain future considerations.

Factors Influencing Suicidal Ideation in Persons with Physical Disabilities.

Suicidal ideation is a leading indicator of suicide risk, particularly among persons with disabilities, a population at high risk of suicide. This study aimed to identify factors affecting suicidal ideation among persons with physical disabilities in Korea. Data for this cross-sectional study were obtained from the Disability and Life Dynamics Panel. Eight hundred and twenty-eight persons with physical disabilities were extracted from the data, and seven hundred seventy people who responded to the suicidal ideation question were included in the analysis. Chi-square and multivariate logistic regression analyses were employed. The results show a high percentage of suicidal ideation among persons with physical disabilities (18.5%). Among the general characteristics, more women were found to have suicidal ideation than men, and people in their 40s and 60s had a higher rate of suicidal ideation than other age groups. A lower educational level was found to be related to suicidal ideation. After controlling for general characteristics, depression increased the likelihood of suicidal ideation among individuals with physical disabilities. Economic difficulties and disability acceptance did not relate to suicidal ideation. Based on the results of this study, continuous observation of suicidal ideation in people with physical disabilities and early intervention programs for preventing depression and increasing disability acceptance are considered necessary.

Emergency treatment of tongue bite after rat poison poisoning in a patient with recurrent depressive disorder: a case report

BackgroundRecurrent depressive disorder (RDD) is mainly manifested as a low mood, negative and pessimistic mood, and often presents suicidal tendencies when severe. This study reports on a patient with RDD who experienced rat poison poisoning occurring tongue biting. The patient’s psychiatric symptoms improved after receiving emergency management and subsequent combined medical care.Case presentationThe patient was a 51-year-old female with RDD complicated with rat poison poisoning. Tongue bite occurred on the third day of hospitalization. She received emergency treatment. Depression, anxiety and suicide risk assessment, safety management and caregiver-health education were conducted on the day of admission and before discharge. At the follow-up after discharge, the risk of suicide was reduced.ConclusionsSuicide in patients with RDD is characterized by repetition and complexity. The occurrence of clinical cases involving tongue bite after gastric lavage is rare. Suicide assessment and emergency management play an auxiliary role in the treatment of patients with recurrent depressive disorder.

Evaluation of MMP-9 enzyme in drug-induced suicide cases admitted to the emergency room

ObjectiveThis study investigates MMP-9 enzyme levels in patients who attempted suicide by taking high doses of drugs, considering their sociodemographic characteristics. MethodsThe study included 45 patients who attempted suicide by high-dose drug intake admitted to the emergency room and 45 healthy volunteers with no neuropsychiatric disorders. Blood samples were collected to measure MMP-9 levels, and informed consent was obtained. The samples were centrifuged and analyzed using the ELISA method, with results statistically compared. ResultsFindings indicate that being single and a student significantly increased suicide tendencies (p = 0.002 and p = 0.001, respectively). Psychiatric disorders were the most common cause at 40.0%, followed by antidepressants (55.6%), analgesics (20.0%), and antidiabetics (8.9%) as the most used drugs for suicide. MMP-9 levels were significantly higher in patients who attempted suicide compared to controls (83.74 (±7.14) ng/mL vs. 54.97 (±12.27) ng/mL, p = 0.001). Additionally, MMP-9 levels were higher in single patients compared to married or divorced individuals (p = 0.008). MMP-9 levels were lower in patients with psychiatric disorders, recent psychiatric services, family history of psychiatric disorders, and previous suicide attempts (p = 0.014, p = 0.046, p = 0.035, p = 0.034). ConclusionsThis study shows MMP-9 enzyme can be a potential biomarker for drug-induced suicide attempts, emphasizing the importance of evaluating MMP-9 levels to assess suicide risk and develop prevention strategies.

Brief online suicide risk assessment of adults does not affect state mood, even in the context of elevated suicidality self-stigma, suicidal ideation and psychological distress.

The current study aimed to assess whether online suicide risk assessment affects state mood and is the first to examine if suicide-related self-stigma or coping related to suicidal ideation are predictors of mood change. The Australian participants (N = 661, Mage = 34.9, SD = 12.3, 57.1% female), recruited through a crowd-sourcing platform, completed a visual analogue mood measure before and after the Suicidal Ideation Attributes Scale (SIDAS), an assessment tool. Followed by a modified version of the Internalised Stigma Scale, the Brief COPE and DASS-21. State mood did not change from pre- to post-suicide risk assessment in the overall sample, t(662) = -.16, p = .868, d = -.01. Contrary to hypotheses, neither self-stigma nor coping were related to mood change following exposure to the SIDAS. The multiple regression model was not significant, F(9,643) = 1.16, p = .31., nor was any single predictor including gender, current Suicide risk β = -.04, t = -.80 or psychological distress β = -.09, t = -1.76, p = .08. These findings suggest that online exposure to a suicide risk tool is unlikely to be iatrogenic in relation to state mood, even in the context of elevated self-stigma, suicidal ideation and psychological distress.

A cross-sectional observational study of suicidal behavior among people in prison at Lajpore Central district jail, India

ABSTRACT Suicidal ideation assessment can help reduce the suicide rate among people in prison. Studies for the assessment of suicidal ideation and risk factors for suicide among inmates have been done in Western countries, but in India, data is lacking regarding the assessment of suicidal ideation among the people in prison. 1. To assess the prevalence of suicidal ideationin people in prison. 2. To identify aggravating factors for suicidal behavior. It was a cross Sectional Observational Study at a district jail, Lajpore, Surat, Gujarat. After permission from the jail authority, people in prison with or without conviction, who were willing to give consent for participation, were enrolled in the study. Semi-structured questionnaires are used to assess socio-demographic profiles. Modified Suicide Ideation scale (MSSI) and General Health Questionnaire (GHQ) and PatientHealth Questionnaire (PHQ) scales were used as materials to assess suicidal ideation and psychiatric comorbidity. Frequency analysis and Pearson correlation among various factors with the use of appropriate statistical methods. Descriptive and qualitative analysis of data was done on 140 incarcerated persons in prison. Analysis showed that 10 (7.1%) people in prison had moderate suicidal ideation in the last 48 hours while 58 (41.4%) people in prison had suicidal ideation at any point in their life. The prevalence of depressive symptoms was high among people in prison. 57.9% had minimal depressive symptoms, while 9.3% had moderate to severe symptoms. Non-convicted inmates from urban areas were having significantly more psychological distress and depressive symptoms than other inmates. Advanced ageof the inmates, negative impact of imprisonment on life, depressive symptoms, and psychosocial distress emerged as risk factors correlated with suicidal ideation. During suicide risk assessment, inmate’s age, the impact of imprisonment, psychosocial distress, and depressive symptoms should be considered as risk factors among people in prison.

Clinical characteristics and suicidal ideation as predictors of suicide: prospective study of 1000 referrals to general adult psychiatry.

Questions often follow the suicide of someone who presented to general adult psychiatry (GAP) when expressing suicidal thoughts: 'Why were they not admitted, or managed differently, when they said they were suicidal?' Answering these questions requires knowledge of the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the general clinical characteristics, including suicidal ideation, of a large sample of patients presenting to a GAP emergency assessment service or referred as non-emergencies to a GAP service. Suicidal ideation was very common, being present in 76.4% of emergency presentations and 33.4% of non-emergency referrals. It was very weakly associated with suicide, varied between different diagnostic categories, and previous assessment by GAP did not appear to affect it. The suicide rate during the contingent episode of care was estimated as 66 per 100 000 episodes. This, and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for clinical decision-making. This is not widely appreciated but has serious consequences for patients and healthcare resources.

Mental Health and Suicide Risk Among High School Students and Protective Factors - Youth Risk Behavior Survey, United States, 2023.

Adolescent mental health and suicide risk remain substantial public health concerns. High pre-COVID rates of poor mental health and suicide-related behaviors have continued to rise, highlighting the need to identify factors that might foster positive mental health outcomes and reduce suicide-related behaviors at population levels. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of mental health and suicide risk indicators and their associations with individual-, family-, and school- or community-level protective factors. Prevalence estimates were calculated for each of the mental health and suicide risk indicators by demographic characteristic. Prevalence ratios adjusted for sex, sexual identity, grade, and race and ethnicity were calculated to examine the association between protective factors and mental health and suicide risk indicators. Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide. Mental health and suicide risk indicators differed by sex, sexual identity, grade, and race and ethnicity. All protective factors were associated with lower prevalence of one or more risk indicators. Findings from this report can serve as a foundation for the advancement of research on protective factors and for the development and implementation of programs, practices, and policies that protect and promote mental health and emotional well-being among youth.

Mental Health Risk Assessment and Safety Planning During UK Covid-19 Pandemic Lockdown: Mixed Methods Survey and Interview Study

Risk assessment and safety planning are central to mental health nursing practice but were seriously affected by the Covid-19 pandemic and associated lockdowns. In this study, we aimed to explore how the UK pandemic lockdowns affected risk assessment and safety planning from the perspective of mental health practitioners. A sequential, mixed methods study design was used. A link to an online survey questionnaire was distributed and semi-structured interviews with a subset of respondents were conducted. Survey data were analysed to describe perceived changes in the frequency and nature of risk assessment and safety planning during the pandemic lockdowns. This was supplemented by thematic analysis of qualitative interview data. In total, 106 practitioners were surveyed and 10 participated in semi-structured interviews. More respondents increased than decreased risk assessment frequency but there was no significant overall change. Remote contact was more common in community settings and largely involved telephone appointments. Participants did not wish to continue with remote working following the pandemic. Risk assessment practice changed in UK mental health services as a result of COVID-19 lockdowns.

Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9 Modified for Teens

Suicide is a leading cause of death in US youths. To assess whether screening with supplemental items 10 to 13 on the Patient Health Questionnaire-9 modified for teens (PHQ-9M) improves prediction of youth suicide attempts beyond the information provided by the first 9 items alone (the PHQ-9). This retrospective cohort study used a retrospective cohort of adolescents aged 12 to 17 years who were screened for depression in outpatient facilities within a pediatric health care system between January 1, 2016, and December 31, 2022, with up to 1 year of follow-up to assess the occurrence of suicidal behavior. Follow-up was completed on December 31, 2023. Screening with the PHQ-9M. This study developed and compared prediction using 3 Cox proportional hazards regression models (CR-9, CR-13, and CR-3) of subsequent suicide attempts, determined by the hospital's electronic health records up to 1 year following the last PHQ-9M screening. The CR-9 model used the PHQ-9 and the CR-13 model used all 13 items of PHQ-9M. The CR-3 model used the 3 most impactful variables selected from the 13 PHQ-9M items and PHQ-9 total score. All models were evaluated across 4 prediction horizons (30, 90, 180, and 365 days) following PHQ-9M screenings. Evaluation metrics were the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC). Of 130 028 outpatients (65 520 [50.4%] male) with 272 402 PHQ-9M screenings, 549 (0.4%) had subsequent suicide attempts within 1 year following the PHQ-9M screening. The AUROC of the CR-9 model in the 365-day horizon was 0.77 (95% CI, 0.75-0.79); of the CR-13 model, 0.80 (95% CI, 0.78-0.82); and of the CR-3 model, 0.79 (95% CI, 0.76-0.81); the AUPRC of the CR-9 model was 0.02 (95% CI, 0.02-0.03); of the CR-13 model, 0.03 (95% CI, 0.02-0.03); and of the CR-3 model, 0.02 (95% CI, 0.02-0.03). The 3 most impactful items using adjusted hazard ratios were supplemental item 13 (lifetime suicide attempts; 3.06 [95% CI, 2.47-3.80]), supplemental item 10 (depressed mood severity in the past year; 2.99 [95% CI, 2.32-3.86]), and supplemental item 12 (serious suicidal ideation in the past month; 1.63 [95% CI, 1.25-2.12]). All of the models achieved higher AUROCs as prediction horizons shortened. In this cohort study of adolescent PHQ-9M screenings, the supplemental items on PHQ-9M screening improved prediction of youth suicide attempts compared with screening using the PHQ-9 across all prediction horizons, suggesting that PHQ-9M screening should be considered during outpatient visits to improve prediction of suicide attempts.

Afektinės būsenos savižudybės procese: patirtys ir formavimosi prielaidos

The emergence of affective states during the process of suicide is regarded as a serious indicator of suicide risk. This study aims to describe the experience of affective states characteristic of the suicide process and to raise assumptions about how these affective states develop over a person’s lifetime. A qualitative approach was employed in this study, with the objective of retrospectively exploring individuals’ life experiences through in-depth semistructured interviews. The research sample comprises 12 participants (4 men, 1 person with a nonbinary gender identity, and 7 women) who had attempted suicide no more than one year prior to the study and were receiving treatment at the Vilnius City Mental Health Centre at the time of data collection. Data were analysed using phenomenological interpretive analysis to identify recurring experiential patterns. The analysis revealed nine main experiential themes: some life difficulties experienced during the suicide process were not perceived as related to suicidality; repeated traumatic events provided a foundation for the formation of deep feelings of deficiency; a compensatory mechanism emerged to fill these feelings of deficiency; exhaustion developed from the effort to maintain this compensatory mechanism; the main trigger directly challenged the compensatory mechanism; an affective state followed the experience of the primary trigger; during the affective state, dissociation may help isolate psychological pain; suicidal thoughts during the affective state are experienced as arising automatically; and suicide is perceived as a means to end suffering. The findings of the study indicate that individuals’ narratives reveal a pattern of the formation of affective states characteristic of the suicide process. Through reflection, individuals are able to intuitively distinguish significant, distressing life events from those irrelevant to the suicide process and reconsider their experiences. This ability is a valuable resource for both intervention and postvention efforts.

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study

ObjectivesThe objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to...

Integrating Previous Suicide Attempts, Gender, and Age Into Suicide Risk Assessment Using Advanced Artificial Intelligence Models.

Integrating Previous Suicide Attempts, Gender, and Age Into Suicide Risk Assessment Using Advanced Artificial Intelligence Models.